Hypertension, Nothing to Stay Silent About
Last November, the ACC/AHA released new guidelines for the treatment of hypertension. Below are a few key themes from the new guidelines, with specifics in the table below.
- NORMAL blood pressure (BP) is categorized as <120/80
- Hypertension, Stage 1 is reading of >130/80
- For patients at increased risk, initiate at least 1 BP lowering medication
- Follow up early (1 month) to see if the medication is effective
- Monthly follow up with dose titration or medication add on until BP control is achieved
- Hypertension, Stage 2 is reading that is greater than or equal to 140/90
- Initiate 2 BP lowering medications (different classes), follow closely, and switch to different medications or titrate until BP control is achieved
How do these guidelines impact the population you take care of?
As an example, analysis of one commercial population that PHO providers are delegated to manage shows that nearly 200 more patients in 2016 (consistent from 2015) across the PHO would have qualified as Hypertension, Stage 1, and would benefit from at least 1 medication as adjunct to lifestyle changes.
What can you do?
- Follow the standards for accurate BP measurement and reinforce these standards with office colleagues who routinely measure BP
- Encourage conversations with your patients about the new guidelines. Please see our Understanding Your Blood Pressure chart to help patients know what their target blood pressure is. (Want copies for your exam rooms? Contact Stephanie Cunningham at firstname.lastname@example.org )
- Educate your patients about the nature of high BP and the risks that you know about, but your patients may not
- High BP is often called the “silent killer” because there are no obvious symptoms
- High BP develops slowly over time
- High BP can be very effectively managed through lifestyle changes and medication, when needed
- There are specific populations that may benefit from specific classes of BP medications. Check out the guidelines for details, or stay tuned for the next article which will highlight those details.
References: 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults Whelton et.al. Journal of the American College of Cardiology Nov 2017, 24430; DOI:10.1016/j.jacc.2017.11.006