High blood pressure is now defined as a reading of 130/80 mm Hg, according to the first new comprehensive guidelines in more than a decade from the American Heart Association (AHA) and the American College of Cardiology (ACC).
The new guidelines eliminate the category of prehypertension, which was used for blood pressures between 120–139/80–89 mm Hg. Patients with those readings now will be categorized as having either elevated (120–129/<80 mm Hg) or Stage 1 hypertension (130–139/80–89 mm Hg). Readings of measures at or above ≥140/≥90 mm Hg are considered Stage 2 hypertension under the new guidelines.
The guidelines strongly recommend a team-based care approach to treatment, and include pharmacists in the discussion.
“There is high-quality evidence demonstrating that team-based care models, particularly with pharmacists and nurses, improves hypertension treatment and control,” said Eric MacLaughlin, PharmD, FASHP, FCCP, BCPS, who coauthored the new guidelines as APhA’s representative member of the Guideline Writing Committee. “With the formal recommendation to use a team-based approach for care of hypertension patients, there would be [an] expanded role and opportunities [for pharmacists].”
The guidelines, often referred to as the 2017 Hypertension Clinical Practice Guidelines, will update and replace the 2003 guidelines published by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.
While more Americans will be classified as having high blood pressure under the new guidelines, only a small percentage more may need medication in addition to the lifestyle changes that are emphasized in the recommendations. The guidelines point out that patients with Stage 1 high blood pressure (130–139/80–89 mm Hg) who also have other issues that increase their risk for heart attack and stroke, such as diabetes, should start medication while also working on lifestyle changes. These patients are also advised to reevaluate with a physician monthly until their numbers are better.
Those with Stage 2 high blood pressure are being advised under the guidelines to start medication—likely two medications—while making healthy lifestyle changes. These patients will then reevaluate monthly with a physician until their numbers are under control.
As for patients with elevated (120–129/<80 mm Hg) blood pressure or Stage 1 (130–139/80–89 mm Hg) who are otherwise healthy, the guidelines say they should make healthy lifestyle changes.
The new guidelines incorporate data from the Systolic Blood Pressure Intervention Trial (SPRINT), which was a large, randomized controlled trial designed to assess the impact of more aggressive versus standard blood pressure goals on hard cardiovascular outcomes.
“SPRINT demonstrated significant benefit with the lower blood pressure goals,” said MacLaughlin, who is also a professor at Texas Tech University Health Sciences Center School of Pharmacy.
Data from SPRINT, which was also used in the new meta-analyses that were done for the guidelines, supports the lower blood pressure goal of <130/80 mm Hg for adults, including adults aged 65 years and older in noninstitutionalized ambulatory, community-living settings, according to MacLaughlin.
In developing the guidelines, authors also analyzed more than 900 research studies, excluding those that did not meet strict research requirements.
APhA supports the guidelines and is committed to advancing pharmacists’ roles in hypertension management in a coordinated team-based care environment. APhA will be providing education for pharmacists on the new guidelines in various capacities, including at the 2018 APhA Annual Meeting & Exposition in downtown Nashville on March 16–19.
Corrected November 14, 2017: The article misstated that data from SPRINT supported the lower blood pressure goal of <130/80 mm Hg for adults, including adults aged 65 years and older in institutionalized ambulatory, community-living settings. It is adults in noninstitutionalized settings, not institutionalized settings.