Managing hypertension: Lowering the threshold and other recommendations

This study summarized recent recommendations from the American College of Cardiology and the American Heart Association on managing hypertension.

Managing hypertension (high blood pressure) is important to prevent serious complications such as cardiovascular disease and stroke.

The American College of Cardiology (ACC) and the American Heart Association (AHA) are made up of clinical professionals that are experts in treating hypertension. To improve patient care, the ACC and AHA commissioned a review of current treatment guidelines.

This report summarized the findings of the ACC/AHA review of managing hypertension.

Blood pressure (BP) classification has changed the term ‘prehypertension’ to ‘elevated BP’ (systolic BP greater than 120 mmHg, diastolic BP less than 80 mmHg). Stage 1 hypertension is now defined as systolic BP 130-139 mmHg and diastolic BP 80-89 mmHg. Stage 2 hypertension is now defined as systolic BP greater than 140 mmHg and diastolic BP greater than 90 mmHg.

Measurement of BP should be performed out-of-office to confirm diagnosis and optimize treatments. Patients should be screened for secondary causes of hypertension to improve treatment. Lifestyle changes (increased exercise and dietary improvement) is recommended for patients newly diagnosed with stage 1 hypertension. Patients with pre-existing cardiovascular (heart and circulatory system) disease (CVD) or at risk of CVD should also be prescribed medication to lower BP.

The recommended target for BP is less than 130/80 mmHg. The following drugs are recommended as the first-line of treatment for newly diagnosed patients: thiazide diuretics, calcium-channel blockers, angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers. Patients with stage 2 hypertension should be prescribed two drugs with different mechanisms of action to improve BP control. Patients with diabetes should receive drug treatment to reduce BP when it reaches 130/80 mmHg and the BP target for these patients is lower than 130/80 mmHg to reduce CVD risk.

Adults over 65 should receive treatment for hypertension (stage 1 and above), aiming for BP levels below 130/80 mmHg. 

This study concluded that that blood pressure categories should be changed to reflect lower limits and effectively manage hypertension.

This review summaries general guidelines for hypertension managment – every patient will need a treatment strategy tailored to suit their needs.

If you have any concerns regarding hypertension please consult with your doctor.