Anaheim, CA—Pharmacists soon could be filling more prescriptions for antihypertensives based on new guidelines published by the American Heart Association (AHA) and the American College of Cardiology (ACC) for detection, prevention, management, and treatment of high blood pressure.
The guidelines, presented at the AHA’s 2017 Scientific Sessions conference in Anaheim, called for treatment—with lifestyle changes for most patients, but medication for some—at 130/80 mm Hg rather than 140/90. The guidelines are the first new official recommendations from those associations in more than a decade and were jointly published in the Journal of the American College of Cardiology and the journal Hypertension.
The upshot? While the previous definition had about one in three, or 32%, of U.S. adults with high blood pressure, the new levels mean that nearly half, 46%, of the U.S. adult population falls into the hypertension category. At the same time, prehypertension has been deleted as a category. The greatest effect is expected to occur with a younger cohort of adults: The prevalence of high blood pressure is expected to triple among men under age 45 and double among women under 45, the article states.
The guidelines emphasize more than in the past, however, that high blood pressure should be diagnosed after two or three readings on at least two different occasion and not after a single measurement or visit.
Guideline developers suggest that their revised definitions will push patients to be treated earlier.
“You’ve already doubled your risk of cardiovascular complications compared to those with a normal level of blood pressure,” with blood pressure levels between 130-139/80-89 mm Hg, pointed out lead author Paul K. Whelton, MB, MD, MSc, of Tulane University in New Orleans. “We want to be straight with people—if you already have a doubling of risk, you need to know about it. It doesn’t mean you need medication, but it’s a yellow light that you need to be lowering your blood pressure, mainly with nondrug approaches.”
Here is how blood pressure will now be defined:
• Normal: Less than 120/80 mm Hg
• Elevated: Top number (systolic) between 120-129 and bottom number (diastolic) less than 80
• Stage 1: Systolic between 130-139 or diastolic between 80-89
• Stage 2: Systolic at least 140 or diastolic at least 90 mm Hg
• Hypertensive crisis: Top number over 180 and/or bottom number over 120, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage.
Of special interest to pharmacists, medication is only recommended for Stage I hypertension if a patient has already had a cardiovascular event, such as a heart attack or stroke, or is at high risk of heart attack or stroke based on age, the presence of diabetes mellitus, chronic kidney disease, or calculation of atherosclerotic risk. The same risk calculator should be used in this situation as the one employed to evaluate high cholesterol, guideline authors advise.
The document also posits that many patients might need two or more types of medications to control their hypertension and endorse combining multiple medications into a single pill as a way to improve medication adherence.
Published November 22, 2017