The American Heart Association and the American College of Cardiology have jointly released joint updated hypertension guidelines. Eleven health organizations have endorsed the new guidelines, which were last updated in 2017.
What's New
A central update is the recommendation for use of the PREVENT calculator to estimate 10- and 30-year risk of heart attack, stroke, or heart failure in patients aged 30 to 79 years. This tool incorporates cardiovascular, kidney, and metabolic health indicators, along with social factors, to guide treatment decisions.
All patients with high blood pressure should undergo a urine albumin-to-creatinine ratio test to evaluate kidney function, wrote Daniel W. Jones, MD, of the University of Mississippi School of Medicine in Jackson.
The recommendations also expand plasma aldosterone-to-renin ratio screening for primary aldosteronism to more patients, including those with obstructive sleep apnea or stage 2 hypertension.
First-line antihypertensive medications highlighted in the new guidelines include angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, long-acting dihydropyridine calcium channel blockers, and thiazide-type diuretics. For stage 2 hypertension, initiating treatment with two drugs, preferably in a combination pill, is recommended. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may be considered in patients with hypertension who also have overweight or obesity.
In patients with chronic hypertension who are pregnant or planning pregnancy, the guideline committee advises that treatment should begin at 140/90 mmHg or higher. Low-dose aspirin at 81 mg per day may be recommended in certain cases to reduce the risk of preeclampsia.
Hypertension can develop or persist following delivery. Specifically, the guideline committee noted that "patients with a history of pregnancy-associated high blood pressure are encouraged to have their blood pressure measured at least annually."
What's Continuing
The target systolic blood pressure for patients with hypertension remains under 130 mmHg, which is supported by evidence that links blood pressure control to reduced cardiovascular events and preserved cognitive function. All current blood pressure categories are maintained.
Lifestyle interventions remain the first-line approach for all patients. They should reduce sodium intake to below 2,300 mg per day, with an ideal target of 1,500 mg per day; follow a heart-healthy diet, such as the DASH eating plan; limit alcohol consumption to no more than 2 drinks per day for men and 1 drink per day for women; engage in 75 to 150 minutes of physical activity (both cardio and weight training) per week; achieve at least 5% weight loss in those with overweight or obesity; manage stress through exercise, meditation, or breathing techniques; and use home blood pressure monitoring to confirm diagnoses and track progress.
Dr. Jones and colleagues noted that some recommendations, such as the use of GLP-1 RAs and certain postpartum management strategies, are based on emerging evidence. They also acknowledge that much of the research that informs these recommendations comes from high-income countries, which may limit applicability in other populations.
“It is important for people to be aware of the recommended blood pressure goals and understand how healthy lifestyle behaviors and appropriate medication use can help them achieve and maintain optimal blood pressure. Prevention, early detection, and management of high blood pressure are critical to long-term heart and brain health, which means longer, healthier lives,” they concluded.
Source: American Heart Association
