In November 2017, the American Heart Association (AHA) and American College of Cardiology (ACC) released a new clinical practice guideline on hypertension. In December 2017, the American Dental Association (ADA) reported the AHA and ACC updates. The guidelines, in a nutshell, state that normal blood pressure is under 120/80 mm Hg. The categories of prehypertension, hypertension stage 1, and hypertension stage 2 have also changed. In this article, I would like to provide a summary and highlight of the new guidelines, while discovering what the changes mean to the dental professional. But let’s start with the basics and review what hypertension is. High blood pressure is a common condition in which the long-term force of the blood against the artery walls is high.(1) Hypertension (high blood pressure) affects 1 of 3 adults or about 75 million people in the United States.(2) This condition is related to the increase risk for heart disease and stroke, two of the leading causes of death in the United States.(3) High blood pressure is called the “silent killer” because it often has no warning signs or symptoms, and many people do not know they have it. In November 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) released a clinical practice guideline for the prevention, detection, evaluation, and treatment of high blood pressure (BP) in adults. In 2014, the ACC and the AHA appointed a multidisciplinary committee to update previous reports of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The committee reviewed literature and commissioned systematic reviews and meta-analyses on out-of-office BP monitoring, the optimal target for BP lowering, the comparative benefits and harms of different classes of antihypertensive agents, and the comparative benefits and harms of initiating therapy with a single antihypertensive agent or a combination of 2 agents. This article summarizes key recommendations in the following areas: BP classification, BP measurement, screening for secondary hypertension, nonpharmacologic therapy, BP thresholds and cardiac risk estimation to guide drug treatment, treatment goals (general and for patients with diabetes mellitus, chronic kidney disease, and advanced age), choice of initial drug therapy, resistant hypertension, and strategies to improve hypertension control. Hypertension is the leading cause of death and disability-adjusted life-years worldwide (1, 2). In the United States, hypertension accounts for more cardiovascular disease (CVD) deaths than any other modifiable risk factor and is second only to cigarette smoking as a preventable cause of death for any reason (3). The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults provides an evidence-based approach to reduction of CVD risk through lowering of blood pressure (BP) (4). In 1977, the National Heart, Lung, and Blood Institute (NHLBI) initiated a series of hypertension guidelines, culminating in the 2003 publication of The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) (5).
The 2017 guideline is an update of “The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure” (JNC 7), published in 2003. This guideline is comprehensive and incorporates new information from studies regarding blood pressure (BP)-related risk of cardiovascular disease (CVD), ambulatory BP monitoring (ABPM), home BP monitoring (HBPM), BP thresholds to initiate antihypertensive drug treatment, BP goals of treatment, strategies to improve hypertension treatment and control and various other important issues. The American College of Cardiology (ACC)—along with collaborative societies—create Clinical Practice Guidelines, which become ACC policy at the time of publication. All Clinical Practice Guidelines undergo rigorous peer review that is independent of the Editors/editorial processes of the Editors receive no compensation from the publication of the guidelines nor other ACC clinical/policy documents. And once again, high blood pressure is making headlines in the news: the American Heart Association and the American College of Cardiology (AHA/ACC) have just released new guidelines about hypertension. Since this development is likely to cause confusion and concern for many, I’m writing this post to help you understand the debate and what this might mean for you and your family. By the way, if you’ve read any of my other blood pressure articles on this site, let me reassure you: I am not changing my clinical practice or what I recommend to others, based on the new AHA/ACC guidelines. The core principles of better blood pressure management for older adults remain the same: Perhaps the most important thing to understand is this: treatment of high blood pressure in older adults offers “diminishing returns” as we treat BP to get lower and lower. Scientific evidence indicates that the greatest health benefit, when it comes to reducing the risk of strokes and heart attacks, is in getting systolic blood pressure from high (i.e. From there, the famous SPRINT study, published in 2015, did show a further reduction in cardiovascular risk, when participants were treated to a lower systolic BP, such as a target of 120. However, this was in a carefully selected group of participants, it required taking three blood pressure medications on average, and the reduction in risk was small. As I note in my article explaining SPRINT Senior, in participants aged 75 or older, pushing to that lower goal was associated with an estimated 1-in-27 chance of avoiding a cardiovascular event.
If you subscribe to any of our print newsletters and have never activated your online account, please activate your account below for online access. By activating your account, you will create a login and password. We've pulled together an abridged version for visual learners. Below you'll find key changes to thresholds for diagnosis and treatment, the algorithm for treatment, how prevalence is projected to change, and more.
These pediatric hypertension guidelines are an update to the 2004 “Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents.” Significant changes in these guidelines include 1 the replacement of the term “prehypertension” with the term “elevated blood pressure,” 2 new normative pediatric blood pressure BP tables based on. Sep 3, 2018. Background The 2017 American College of Cardiology/American Heart Association ACC/AHA blood pressure BP guideline provides.