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Do you know the new high blood pressure guidelines by ACC/AHA?
Jan 23, 2018

High blood pressure should be treated earlier with lifestyle changes and in some patients with medication – at 130/80 mm Hg rather than 140/90 – based on new ACC and American Heart Association (AHA) guidelines for the detection, prevention, management and treatment of high blood pressure.


The new guidelines – the first comprehensive set since 2003 – lower the definition of high blood pressure to account for complications that can occur at lower numbers and to allow for earlier intervention. The new definition will result in nearly half of the U.S. adult population (46 percent) having high blood pressure, with the greatest impact expected among younger people. Additionally, the prevalence of high blood pressure is expected to triple among men under age 45, and double among women under 45, the guideline authors note. However, only a small increase is expected in the number of adults requiring antihypertensive medication.


Chinese experts say, according to this new standard, more Chinese would become patients who suffer from high blood pressure.According to Chinese official estimates, about 270 million Chinese have high blood pressure.


"You've already doubled your risk of cardiovascular complications compared to those with a normal level of blood pressure," said Paul K. Whelton, MB, MD, MSc, FACC, lead author of the guidelines. "We want to be straight with people – if you already have a doubling of risk, you need to know about it. It doesn't mean you need medication, but it's a yellow light that you need to be lowering your blood pressure, mainly with non-drug approaches."


Blood pressure categories in the new guideline are:

NORMAL

Less than 120/80 mm Hg

Elevated

Systolic between 120-129 and diastolic less than 80;

Stage 1

Systolic between 130-139 or diastolic between 80-89

Stage 2

Systolic at least 140 or diastolic at least 90 mm Hg

Hypertensive crisis

Systolic over 180 and/or diastolic over 120, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage


Difference between previous and new guidelines:

Previous guidelines(2003)

New guidelines(2017)

prehypertension

either Elevated (120-129 and less than 80) or Stage I hypertension (130-139 or 80-89)

140/90 mm Hg as Stage 1 hypertension

140/90 mm Hg classified as Stage 2 hypertension


stress the importance of using proper technique to measure blood pressure; recommend use of home blood pressure monitoring using validated devices; and highlight the value of appropriate training of health care providers to reveal "white-coat hypertension.


Only prescribing medication for Stage I hypertension if a patient has already had a cardiovascular event such as a heart attack or stroke, or is at high risk of heart attack or stroke based on age, the presence of diabetes mellitus, chronic kidney disease or calculation of atherosclerotic risk (using the same risk calculator used in evaluating high cholesterol)

Recognizing that many people will need two or more types of medications to control their blood pressure, and that people may take their pills more consistently if multiple medications are combined into a single pill.

Identifying socioeconomic status and psychosocial stress as risk factors for high blood pressure that should be considered in a patient's plan of care.


Wenzhou Jianda Medical thinks the new ACC/AHA guidelines were developed in order to remind more people especially young people to pay attention to health. Not everyone who is classified to have high blood pressure shall take medicines. They can reduce risks by changing life style, for example, reducing weight, drinking less alcohol.

People who have high blood pressure shall buy blood pressure monitors and testing blood pressure at home. It is suggested that they shall test blood pressure at least two times with aneroid sphygmomanometers or digital blood pressure monitors before taking medicines in the morning and before supper with one minute interval between each of the two times.Then take an average of the two and take it down. If the medicine of reducing blood pressure is changed, the people shall keep a one week’s record of blood pressure two weeks after changing of medicines. These records shall be then submitted to doctors for assessment.








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