The American Heart Association (AHA) and The
American College of Cardiology (ACC) has changed the definition of
hypertension for the first time in 14 years, moving the number from the old
standard of 140/90 to the newly revised 130/80.
According to
the new definition, 130 to 139 mm Hg systolic and or 80 to 89 mm Hg will be
labelled as stage 1 hypertension.
The
guidelines were released here at the American Heart Association(AHA) 2017 Scientific Sessions : November 11–15, 2017, Anaheim,
California and published simultaneously in the Journal of the
American College of Cardiology,and in the AHA journal Hypertension.
The
definition of the normal blood pressure has not changed in the new
classification , but the new guidelines eliminate the class of ‘
pre-hypertension’.
Previously a
systolic pressure between 120 and 129 and diastolic pressure less than 80 mm Hg
was classified as pre-hypertension, now it is defined as elevated BP and a
systolic pressure 130 to 139 or a diastolic pressure of 80 to 89 mm Hg is
labelled as stage 1 hypertension.
This new
classification raises the prevalence of hypertension from 31.9% to 45.6% and
number of Americans with hypertension from 72.2 to 103.3 million.
In patients
who are labelled as stage 1 hypertension, the treatment will be guided by
underlying cardiovascular risk: only those with clinical cardiovascular disease
or an estimated risk of 10% or more of atherosclerotic cardiovascular disease
(ASCVD) would be offered treatment, and the remainder should be given advice on
lifestyle modification.
Dr Robert M
Carey (University of Virginia School of Medicine), Vice-chair of the writing
committee said in a briefing, "Lifestyle modification is the cornerstone
of the treatment of hypertension, and we expect that this guideline will cause
our society and our physician community to really pay attention much more to
lifestyle recommendations."
Specific
recommendations include advice to lose weight, follow a DASH-pattern diet,
reduce sodium to less than 1500 mg/day and increase potassium intake to 3500
mg/day through dietary intake, increase physical activity to a minimum of 30
minutes of exercise three times per week, and limit alcohol intake to two
drinks or less per day for men and one or less for women.
The new
goals of treating hypertension has also decreased since the last guideline,
lowering it from 140/90 mm Hg to a target of 130/80 mm Hg.
The
guidelines were developed after a thorough and systematic scientific review of
over 900 publications over 3 years and felt that lowering the BP limit will
improve the cardiovascular health of all Americans.
The notable
studies were SPRINT and ACCORD trials, in
which lowering the blood pressure reduced CVD morbidity and mortality without
any increased risk for falls or orthostatic hypotension.
New release by AHA
Full text PDF in Journal Hypertension
Understanding the 2017 Hypertension Guidelines
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