Overview
The 2017 ACC/AHA guidelines focus on prevention, detection, evaluation, and management of high blood pressure (BP) in adults. These guidelines replace the 2003 JNC 7 recommendations and introduce significant updates, including the role of ambulatory/home BP monitoring, treatment thresholds, BP goals, and strategies for improving hypertension control.
BP Categorization
- Normal BP: <120/<80 mmHg
- Elevated BP: 120–129/<80 mmHg
- Stage 1 Hypertension: 130–139/80–89 mmHg
- Stage 2 Hypertension: ≥140/≥90 mmHg
Note: Diagnosis requires an average of ≥2 readings on different occasions. Either systolic or diastolic values qualifying is sufficient for staging.
Out-of-Office BP Monitoring
- Strongly recommended for accurate diagnosis and prognosis.
- Methods:
- Ambulatory BP Monitoring (ABPM): Gold standard but less convenient.
- Home BP Monitoring (HBPM): Practical and reliable when validated devices are used.
BP Patterns
- Normal Tension: Normal BP in both office and home settings.
- Sustained Hypertension: Elevated BP in both settings.
- White Coat Hypertension: Elevated office BP but normal home BP.
- Masked Hypertension: Normal office BP but elevated home BP.
Hypertension and Cardiovascular Risk
- Continuous BP elevation is a significant independent risk factor for cardiovascular disease (CVD).
- Risk doubles with each 20 mmHg systolic or 10 mmHg diastolic rise above 115/75 mmHg.
- Hypertension is a leading cause of mortality globally, surpassing other risks like smoking and high blood sugar.
Types of Hypertension
- Primary Hypertension: Idiopathic; associated with age-related factors and arteriosclerosis.
- Secondary Hypertension: Caused by underlying conditions (e.g., renal artery stenosis, pheochromocytoma, hyperaldosteronism).
- Resistant Hypertension: Uncontrolled BP despite three medications, including a diuretic.
Screening for Secondary Hypertension
Screen for secondary causes if:
- Onset before age 30 or abrupt worsening.
- Resistant hypertension.
- Associated symptoms (e.g., hypokalemia, adrenal nodules, headaches, palpitations).
Common Cause: Primary Hyperaldosteronism, prevalent in 5–10% of new hypertensives and 20–25% of resistant cases.
Recommended Tests
- Basic: Fasting blood glucose, lipid profile, CMP, CBC, thyroid function, urinalysis, EKG.
- Optional: Echocardiogram, uric acid, urinary albumin-to-creatinine ratio.
BP Management Goals
- Target BP: <130/80 mmHg for most adults.
- Lifestyle Modifications:
- Sodium reduction.
- Regular physical activity.
- Weight management.
Therapeutic Highlights
- Every 5 mmHg BP reduction decreases CVD risk by ~10%.
- Early diagnosis and consistent management, including antihypertensive medications, are critical for long-term cardiovascular health.
Self-Monitoring Tips
- Measure BP twice daily (morning and evening) with validated devices.
- Avoid smoking, caffeine, or exercise 30 minutes before measurements.