2017 Hypertension Clinical Practice Guidelines and Prevention

2017 Hypertension Clinical Practice Guidelines and Prevention


– Hello, I’m Donald Lloyd-Jones, Chair of the AHA’s Council on
Epidemiology and Prevention. I’m here at New Orleans at
the EPI Lifestyle meetings with Dr. Paul Whelton. He is from Tulane University. Paul, thank you so much for
welcoming us to your nice city. We just had a presentation
of the 2017 AHA ACC hypertension guidelines
which were presented to great fanfare at last
November’s AHA Scientific Sessions. Paul, why don’t you tell
us a little bit about the major changes that were represented in the 2017 guidelines. – A couple of big things. We emphasized the importance
of accurate measurement of blood pressure and the
rule of getting measurements outside of the office, which we now recognize
to be very important. We redefined the
classification of hypertension. So where it used to be 140/90, we’re now saying 130/80. That adds about 14% to the prevalence of about 30 million adults. So that wasn’t a step
that we took lightly, but they are at high
risk and they can benefit from reducing their blood pressure. The next thing we did was
look at the strategies for how to make decisions about treatment. The underpinning treatment for everyone with high blood pressure
is non-pharmacological. Most of this can be improving lifestyles, improving diet, improving
physical activity. For those who have a high underlying risk it’s valuable to add in any
hypertensive drug therapy. So that new category of
stage one hypertension, 130 to 139 systolic, 80 to 89, most of them, about 70%
are not at high risk, and they really ought to be managed with lifestyle improvements. But for that 30% who are at high risk, they’re going to benefit
from a drug as well. So that’s an important change. Because we’re more targeted
on who should get a drug we actually don’t increase the prevalence of recommendations for drug therapy much over previous guidelines. Another big change was the
target for blood pressure, and a lot of new trials indicate to us that we ought to be aiming
for lower blood pressures than we recommended in
previous guidelines. So we’re now suggesting
less than 130 systolic. That’s really where we have the great confidence to be healthful. For practitioners we say that’s equivalent to about 80 millimeters
of mercury diastolic. Collectively improving the diagnosis, being more thoughtful about who to get any hypertensive drug therapy,
and lowering the target for blood pressure, all
those things are likely to improve the health
of adults in the U.S. and hopefully our guideline
will be helpful to providers. One thing we also really
stressed is how to improve control rates because we’ve
done better over time, but we’re still not doing anything as well in the general aspect
of treatment than we see in some of the well
organized systems of care. So we’re at about 50%
control for the 140/90. We know we can get that up to about 90%. So there are a lot of
strategies we’ve learned now that can help practitioners
to improve control rates. Those are some of the big aspects, but there’s a lot in the guideline, and for particular
situations where a clinician might have a question, they can go in and get the
information pretty quickly and we hope it’ll be
helpful to the clinician. – Paul, these guidelines were endorsed by a number of different societies. But as always when they come out I think people take time to digest them. There’s perhaps a little
bit of controversy. How do you see the reception so far? – I think for the most part pretty good, especially those who’ve really
looked at the guidelines, they sort of make sense. We stewed over them for about three years. It’s not easy to change and we always have disagreement around the margins, but I think most people are pretty much in the same page for the
major recommendations. So I hope that they will be helpful. I hope that they will be embraced. And I’m confident that
if they are embraced, maybe not 100%, but even 90% of it, it’ll really help in
practice and it’ll improve cardiovascular health for
the U.S. adult population. – Any really indications
of uptake by practitioners? – I think too early to say. A lot of positive feedback, but a little too early to
say at this point in time. We are very consistent, I might add, with the Canadian’s and certainly the target recommendation. The Australians were actually a little more cautious than they would be. Europeans are going to be coming out with their guidelines. They are also like ours, important and influential
around the world. We’ll see in the summer. But I have a feeling
that they’re going to be closer to us and less different. So hopefully we can all get on a page that is fairly consistent with one another and we’ll achieve the
goal of our 11 supporting organizations and that’s to
improve cardiovascular health. – So to recap new approaches to diagnosing and classifying high blood pressure that really recognized the risk that exists in the population. More intensive treatment
to get to lower targets in those in whom drug therapy is required. And a lot of nice approaches, I think, for the management of blood pressure, both with individual patients
and in health systems. So Paul, I want to thank you very much for being here with us. I hope everyone will take the opportunity to read the guidelines
and get to know them. – Thank you.

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