On Monday November 13, 2017, the American Heart Association (AHA) published in its journal Hypertension, the 2017 High Blood Pressure Clinical Practice Guideline for the prevention, detection, evaluation, and treatment of high blood pressure (BP). The guideline was developed by the AHA in collaboration with the American College of cardiology (ACC) and has been in development since 2014. According to the ACC/AHA, the guideline represents the official policy of the ACC and AHA and is based on systematic methods to evaluate and classify evidence, and provides the cornerstone for quality cardiovascular care.
The 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 by the National Heart, Lung, and Blood Institute (NHLBI). New information from studies of office-based BP-related risk of cardiovascular disease, ambulatory BP monitoring (ABPM), home BP monitoring (HBPM), and telemedicine, are some of the areas incorporated into the new guideline.
Here are 3 take-aways you should know
- Blood pressure should be categorized as normal, elevated, stage 1 or stage 2 hypertension, to prevent and treat high BP
This classification is based on office pressures – average BP measured in a healthcare setting – and differs from the previous recommendation of JNC 7 in that stage 1 hypertension is now classified as a systolic BP (SBP) of 130-139 mmHg or a diastolic BP (DBP) of 80-89 mmHg and stage 2 hypertension now corresponds to what were stages 1 and 2 in JNC 7.
Normal: ˂120 mmHg and ˂80 mmHg
Elevated: 120-129 mmHg and ˂80 mmHg
Stage 1: 130-139 mmHg or 80-89 mmHg
Stage 2: ≥140 mmHg or ≥90 mmHg
It is recommended that individuals be placed in the higher BP category if they have systolic BP and diastolic BP in 2 categories. It should also be noted that BP is based on an average of ≥2 careful readings obtained on ≥2 occasions.
This means that policies and procedures relating to the diagnosis of hypertension will have to be amended to reflect these updates. Additionally, prevention programs including patient educational materials and screening will need to be adjusted to further reach at-risk populations.
- Prevalence of hypertension is now substantially higher among US adults
With the new guidelines for categorizing BP, 46% of US adults are now classified as hypertensive compared with 32% using JNC 7. This increased burden of hypertension means there will need to be changes to policies, procedures, programs, guidelines, and materials designed for the management and treatment of the condition.
- Despite increase in prevalence of hypertension, increase in the number of persons requiring medication is small
The guideline recommends non-pharmacologic treatment instead of anti-hypertensive medication for most of the adults now classified as hypertensive but would not have been so classified using JNC 7. Therefore, the new guideline results in only a small increase in the percentage of adults for whom antihypertensive medication along with lifestyle modification is recommended and as such, will not greatly impact medication prescribing practices.
As previously noted, this change in the classification of BP will directly impact policies and procedures in healthcare organizations. So, what can you do?
- Amend policies to align with the new categories of BP and other recommendations in the guideline
- Ensure there are policies in place to indicate that BP should be based on an average of ≥2 careful readings obtained on ≥2 occasions
- Amend/create policies to outline when antihypertensive medications should be prescribed as opposed to recommendations of lifestyle modifications, or both
- Re-structure patient-centered programs to reflect the new recommendations
- Educate staff about the changes, what needs to be done, and how
Ensure that your healthcare practices are not lagging. keep up-to-date with the research and clinical recommendations from the ACC/AHA to ensure that you are providing your patients with the best possible care based on the latest scientific recommendations.