The first new comprehensive hypertension guidelines for U.S. practitioners in nearly 15 years will be rolled out at Scientific Sessions on Monday.
The guidelines will be discussed in a series of three afternoon symposia:
“The 2017 Hypertension Clinical Practice Guidelines” begins at 2 p.m. in Main Event I, Hall D, Main Building.
“Target: BP™ 2017 Update and Lessons Learned from Participating Practices” begins at 3:45 p.m. in Ballroom A, 3rd Level, Main Building.
“Clinical Practice Guidelines for Blood Pressure Management: Next Steps” starts at 5:15 p.m. in Ballroom A.
About half of U.S. adults are unaware that they have hypertension or are untreated or undertreated.
“The good news is that we have made tremendous progress in the U.S. on blood pressure management, but as much as we recognize the success we have had, we have more work to do,” said Paul K. Whelton, MD, MSc, who chaired the joint AHA/ACC committee that created the guidelines. “We hope the new guidelines will prove to be a valuable resource for clinicians in improving the detection, prevention and management of high blood pressure.”
The last comprehensive hypertension guidelines in the United States were published in 2003 in the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7).
“We have an enormous amount of new information, both on the risk side of hypertension and on the treatment side from major clinical trials,” said Whelton, clinical professor and the Show Chwan Health System Endowed Chair in Global Public Health at the Tulane University School of Public Health and Tropical Medicine in New Orleans, Louisiana.
“The guidelines cover everything from the classification of blood pressure and blood pressure measurement issues to diagnosis of hypertension, prevention of high blood pressure and management of hypertension in both the general population and in higher-risk populations, such as older adults, pregnant women, individuals with diabetes mellitus and those with specific comorbidities.”
A 21-member multidisciplinary writing committee developed the guidelines using a precise, structured system based on a series of clinical questions addressed with comprehensive literature reviews, including systematic reviews and meta-analyses conducted by an independent evidence-review committee. Each recommendation has an assigned class to indicate its strength and a rating to show the level of supporting evidence. Extensive evidence and literature tables support each recommendation.
One of the most important developments since the publication of JNC 7 is an appreciation for the impact of blood pressure measurements on clinical decisions, Whelton said. That’s why the new guidelines focus extensively on measurement issues, including how to measure blood pressure in and outside the office, and the practical value of out-of-office measurements.
U.S. clinical practice has focused on blood pressure measurement in the office, which represents a small window on a patient’s blood pressure throughout the day. Recognizing white-coat hypertension and masked hypertension are important aspects of blood pressure management, Whelton said. Those patients appear to be at similar risk for cardiovascular events as those with hypertension sustained in and out of the office.
In developing the guidelines, Whelton said the committee devoted a good deal of attention to nonpharmacological approaches to preventing and managing high blood pressure and addressed pharmacologic management in detail, including who should be treated, which drugs should be used in specific patient groups and the targets for blood pressure control.