Hypertension management : ACC-AHA guideline summary

The ACC/AHA hypertension guidelines provide comprehensive directives for managing hypertension, encompassing diagnosis, evaluation, treatment, and monitoring. They emphasize accurate blood pressure measurement, acknowledging that most measurement errors tend to overestimate blood pressure. This can lead to the over-diagnosis of hypertension and potential over-treatment in patients already on medication. The guidelines also introduce innovative approaches, particularly in how they use absolute cardiovascular risk to guide treatment decisions.

Key Points

• Accurate Blood Pressure Measurement:

  • Critical for diagnosis and treatment.
  • Errors in measurement often lead to over-diagnosis and over-treatment.
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• Diagnosis of Hypertension:

  • Hypertension is diagnosed with consistent readings of ≥130 systolic and/or ≥80 diastolic mm Hg.
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• Treatment Thresholds:

  • Stage 1 hypertension (130–139/80–89 mm Hg) doesn’t always require immediate drug therapy.
  • High-risk patients (e.g., those aged 65 and older, with diabetes, CKD, or known CVD) start medication at ≥130/80 mm Hg.
  • Exception for high-risk: Secondary stroke prevention starts treatment at ≥140/90 mm Hg in drug-naïve patients.
  • Non-high-risk individuals start medication at ≥140/90 mm Hg.
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• Treatment Targets:

  • Target BP for most is <130/80 mm Hg.
  • For those 65 and older, target systolic BP is <130 mm Hg, with no specific diastolic target.
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• Initiating Treatment:

  • Use two drugs with complementary actions...