New AHA/ACC hypertension guidelines: 130/80 is the new abnormal

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Takeaway

  • New guidelines from the American Heart Association (AHA)/American College of Cardiology (ACC) establish lower treatment cutoffs for hypertension.
  • The cutoffs are changing from 140/90 mmHg to 130/80 mmHg.
  • These changes, part of the first comprehensively updated hypertension guidelines in 14 years, mean that almost half of US adults will have hypertension, up from about a third under previous cutoffs.
  • These increases will be greater among younger adults, with cases doubling among women <45 y (from 10% to 19%) and tripling among men <45 y (from 11% to 30%).
  • Ethnic groups all will have similar prevalence increases of about 10% among women and about 16% among men.
  • Guidelines call for lifestyle modification as treatment in some cases, so that not all reclassified cases of hypertension will need medication.
  • Guideline authors note that most people whom this expanded definition captures have previously been told that they have hypertension, along with advice to make lifestyle changes.

Highlights

  • BP categories are redefined so that
    • 120-129 systolic and <80 diastolic is “elevated”;
    • 130-139 systolic or diastolic 80-90 is Stage 1;
    • 140+ or diastolic 90+ is Stage 2;
    • and >180/>120 is hypertensive crisis. 
  • The prehypertension category has been eliminated.
  • Stage 1 requires medication only in the setting of cardiovascular event history or high age-related risk, high atherosclerotic risk (calculator here), diabetes mellitus, chronic kidney disease, and heart failure.
  • Algorithms provided for management in specific populations (eg, acute ischemic or previous stroke, diabetes, pregnancy). 
  • Medication choices in cases of >1 drug therapy should take into account better adherence with combination pills.
  • Home monitoring should be used to rule out white-coat hypertension. 
  • Factors such as stress, socioeconomic status should be identified in risk considerations.
  • Using proper measuring technique is stressed, including taking an average of readings on separate occasions.
  • Guidelines also address team-based care and e-health approaches to treatment.