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Published on: December 5, 2020
Contemporary Drug Treatment of Hypertension: Focus on Recent Guidelines
Wilbert S Aronow1, William H Frishman2
1Cardiology Division and the Department of Medicine, Westchester Medical Center and New York Medical College, Macy Pavilion, Room 141, Valhalla, NY, 10595, USA. wsaronow@aol.com.
Insights
The 2017 hypertension guidelines define high blood pressure (BP) at 130/80 mmHg, recommending lifestyle changes for elevated BP. Treatment with medication and lifestyle changes is advised for secondary and primary cardiovascular disease prevention based on risk factors and BP levels.
Area of Science:
- Cardiology
- Hypertension Management
- Preventive Cardiology
Background:
- The 2017 ACC/AHA hypertension guidelines established new diagnostic thresholds for hypertension.
- Elevated blood pressure (BP) is defined as systolic BP (SBP) 120-129 mmHg with diastolic BP (DBP) <80 mmHg.
- Hypertension is diagnosed at SBP ≥130 mmHg or DBP ≥80 mmHg.
Purpose of the Study:
- To outline the treatment strategies for elevated BP and hypertension according to the 2017 ACC/AHA guidelines.
- To detail the indications for lifestyle modifications and pharmacologic interventions for cardiovascular disease (CVD) prevention.
- To specify BP targets for various patient populations, including those with existing CVD and specific risk factors.
Main Methods:
- The guidelines recommend lifestyle measures for individuals with elevated BP.
- For secondary prevention in patients with clinical CVD, lifestyle measures plus BP-lowering drugs are recommended if SBP ≥130 mmHg or DBP ≥80 mmHg.
- For primary prevention, treatment decisions are based on estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk and BP levels.
Main Results:
- Lifestyle measures are the first line of treatment for elevated BP.
- BP-lowering drugs combined with lifestyle measures are indicated for secondary CVD prevention in patients with clinical CVD and BP ≥130/80 mmHg.
- Pharmacologic treatment is recommended for primary CVD prevention in individuals with ASCVD risk ≥10% and BP ≥130/80 mmHg, or ASCVD risk <10% and BP ≥140/90 mmHg.
Conclusions:
- White coat hypertension should be excluded before initiating antihypertensive therapy in low ASCVD risk individuals.
- Target BP is <130/80 mmHg for patients with coronary heart disease, heart failure, chronic kidney disease, post-renal transplant, secondary stroke prevention, lacunar stroke, peripheral arterial disease, diabetes mellitus, and adults >65 years.
- The selection of specific antihypertensive drug treatments is a key consideration in managing hypertension.
Abstract:
The 2017 American College of Cardiology/American Heart Association hypertension guidelines diagnose hypertension if systolic blood pressure (SBP) is ≥ 130 mmHg or diastolic blood pressure (DBP) is ≥ 80 mmHg. Increased BP is SBP 120-129 mmHg with DBP < 80 mmHg. Lifestyle measures should be used to treat individuals with increased BP. Lifestyle measures plus BP-lowering drugs should be used for secondary prevention of recurrent cardiovascular events in individuals with clinical cardiovascular disease (coronary heart disease, congestive heart failure, or stroke) and an average SBP ≥ 130 mmHg or an average DBP ≥ 80 mmHg. Lifestyle measures plus BP-lowering drugs should be used for primary prevention of cardiovascular disease in individuals with an estimated 10-year risk of atherosclerotic cardiovascular disease (ASCVD) ≥ 10% and an average SBP ≥ 130 mmHg or an average DBP ≥ 80 mmHg. Lifestyle measures plus BP-lowering drugs should be used for primary prevention of cardiovascular disease in individuals with an estimated 10-year risk of ASCVD < 10% and an average SBP ≥ 140 mmHg or an average DBP ≥ 90 mmHg. White coat hypertension must be excluded before starting antihypertensive drug treatment in individuals with hypertension with a low risk for ASCVD. BP should be lowered to < 130/80 mmHg in patients with coronary heart disease, heart failure, or chronic kidney disease; after renal transplantation; for secondary stroke prevention; in lacunar stroke, peripheral arterial disease, and diabetes mellitus; and in ambulatory community-dwelling adults aged > 65 years. The selection of antihypertensive drug treatment is discussed.
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