Clinical Implications of the 2017 ACC/AHA Hypertension Guidelines

Hypertension (HTN) is the primary modifiable risk factor for cardiovascular (CV) morbidity and mortality, affecting nearly half of the adults in the United States.1 The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) HTN guidelines developed new standards for the detection, evaluation, and management of high blood pressure (BP).2 A major shift from prior guidelines is the new definition of Stage 1 HTN as a systolic blood pressure (SBP) of 130–139 mmHg or a diastolic blood pressure (DBP) of 80–89 mmHg and Stage 2 HTN as a BP ≥ 140/90 mmHg (Table 1).2 The new recommendations also emphasize accurate clinic and out of office BP measurements to diagnose and manage HTN. ... Pharmacologic treatment is recommended for Stage 1 HTN only if the patient has clinically evident atherosclerotic cardiovascular disease (ASCVD) or an estimated 10-year cardiovascular risk ≥ 10% using the ACC/AHA Pooled Cohort Equation (http://tools.acc.org/ASCVD-Risk-Estimator-Plus). Non-pharmacologic therapies including weight loss, Dietary Approaches to Stop Hypertension (DASH) diet, alcohol intake optimization, and physical activity are emphasized as primary interventions for all adults with BP ≥ 120/80 mmHg. A multidisciplinary team-based care approach for management is recommended to meet the new ambitious blood pressure goals.