AHA/ACC Issues New Hypertension Guidelines

Diagnosis

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  Blood pressure (BP) should be categorized as normal (<120/80 mm Hg), elevated (120-129/<80 mm Hg), stage 1 hypertension (130-139/80-89 mm Hg), or stage 2 hypertension (≥140/90 mm Hg) (strong recommendation; moderate-quality evidence).

  
  


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  Out-of-office BP measurements are recommended to confirm the diagnosis of hypertension and for titration of BP-lowering medication in conjunction with telehealth counseling or clinical interventions (strong recommendation; high-quality evidence).

  
  

Initiating therapy

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  Many nonpharmacologic interventions that are effective in lowering BP are recommended for people with elevated BP or hypertension (strong recommendation; high-quality evidence).

  
  


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  Blood pressure–lowering medication is recommended for patients with clinical CVD or an estimated 10-year atherosclerotic CVD (ASCVD) risk of 10% or higher who have a systolic BP (SBP) of 130 mm Hg or higher or a diastolic BP (DBP) of 80 mm Hg or higher (strong recommendation; high-quality evidence [for SBP] and expert opinion [for DBP]).

  
  


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  For patients with no history of CVD and an ASCVD risk of less than 10%, BP-lowering medication is recommended for patients who have an SBP of 140 mm Hg or higher or a DBP of 90 mm Hg or higher (strong recommendation; low-quality evidence).

  
  

Management

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  In patients with CVD or ASCVD event risk of 10% or higher, a BP target of less than 130/80 mm Hg is recommended (strong recommendation; moderate-quality evidence [for SBP] and expert opinion [for DBP]). A BP target of less than 130/80 mm Hg may also be reasonable in low-risk patients (weak recommendation; moderate-quality evidence [for SBP] and expert opinion [for DBP]).

  
  


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  In patients warranting pharmacotherapy, thiazide diuretics, calcium channel blockers (CCBs), and angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) are recommended as first-line agents (strong recommendation; high-quality evidence).

  
  


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  Patients with stage 2 hypertension and an average BP of more than 20/10 mm Hg above their BP target should begin therapy with 2 first-line agents of different classes (strong recommendation; expert opinion).