American Heart Association Scientific Statement
Summary High blood pressure (BP) is the leading cause of morbidity and mortality from cardiovascular diseases worldwide. Patients and physicians treating hypertension have benefited from evidence from event-based randomized controlled clinical trials. One result of those trials has been the development of evidence-based guidelines. The commitment to using evidence from these randomized event-based trials has been a cornerstone in the development of guideline treatment recommendations. However, in some situations, evidence from event-based trials is not available for guideline writers or clinicians to assist in making treatment decisions. Such is the case in the treatment of many patients with stage 1 hypertension . The purpose of this scientific statement is to provide complementary information to the 2017 Hypertension Clinical Practice Guidelines for the patient with untreated stage 1 hypertension (systolic BP/diastolic BP, 130-139/80-89 mm Hg) at risk. of atherosclerotic cardiovascular disease <10% not achieving target systolic/diastolic BP (<130/80 mm Hg) after 6 months of guideline-recommended lifestyle therapy. This statement provides evidence from sources other than event-based randomized controlled clinical trials and offers therapy options for clinicians to consider. |
Health care professionals should consider prescribing medications to patients with mildly elevated blood pressure if levels do not decrease after six months of healthy lifestyle changes, according to a new scientific statement from the American Heart Association. The statement, published in the Association’s journal Hypertension , fills a gap in the guideline recommendations by addressing how to manage untreated stage 1 high blood pressure , levels of 130-139/80-89 mm Hg, which are not fully addressed in 2017. treatment guidelines.
The 2017 American College of Cardiology/American Heart Association Blood Pressure Management Guidelines recommendation for patients with stage 1 hypertension and a low (<10%) risk of heart attack or stroke within 10 years is to try first with healthy lifestyle changes and then repeat blood pressure monitoring in six months.
For patients with stage 1 hypertension and a high (>10%) 10-year risk of heart attack or stroke, the guidelines recommend antihypertensive medications in addition to a healthy lifestyle.
Today’s scientific statement suggests that physicians should consider medication for patients at ten-year low risk if blood pressure goals (<130/80 mm Hg) are not met after six months of sustained lifestyle changes healthy. This new guideline would apply to nearly 10% of American adults with high blood pressure.
"There are no treatment recommendations in current guidelines for patients who are at relatively low short-term risk of heart disease when blood pressure does not fall below 130 mm Hg after six months of recommended lifestyle changes," said Dr. Daniel W. Jones, FAHA, chair of the statement writing group, professor and dean emeritus of the University of Mississippi School of Medicine in Jackson, Mississippi, and former president of the American Heart Association. "This statement fills that gap."
Many patients who have stage 1 high blood pressure are adults under 40 years of age. Randomized controlled trials following these patients for cardiovascular disease risk are lacking; therefore, the statement writing committee relied on other forms of evidence, including observational studies focused on the relationship between blood pressure and cardiovascular disease.
"We know that people with blood pressure below 130/80 mm Hg have fewer cardiovascular risk markers such as elevated coronary calcium, an enlarged heart, or a buildup of fatty deposits called atherosclerosis in the arteries of the neck. There is strong evidence that treatment "High blood pressure saves lives by reducing the risks of heart attack and stroke," Jones said.
Healthy lifestyle changes to lower blood pressure include achieving ideal body weight, exercising (30 minutes on most days of moderate to vigorous physical activity, if possible), limiting sodium in the diet, increasing potassium intake and follow the Dietary Approaches to Stop Hypertension (DASH) diet (combined fruit and vegetable diet with low-fat dairy products and saturated fat and reduced total fat). Additionally, patients should be advised to limit alcohol consumption and not smoke. These remain the cornerstone of cardiovascular disease prevention.
"If after six months with lifestyle changes, the measurement does not improve, doctors should consider adding medications to control blood pressure," Jones said.
"That’s an important message for patients to hear too because they should monitor their blood pressure regularly to monitor progress. If they’re not achieving an average daily systolic blood pressure of less than 130 mm Hg, it’s probably time to start a conversation with their doctor about next practical steps, which may include adding medications, to control your blood pressure."
For people who took blood pressure-lowering medications as teenagers, there is evidence that, without intervention, these people are likely to develop markers of cardiovascular disease in young adulthood. The statement suggests that the original indication for starting treatment, usually to avoid long-term organ damage from high blood pressure, should be considered when evaluating the need to continue medication.
The drafters of the statement recognize that the goals of lifestyle change are difficult to achieve and maintain over time. "It is very difficult in the United States and most industrialized countries to limit sodium enough to lower blood pressure," Jones said, "and it is difficult for everyone to maintain a healthy weight in what I call a toxic food environment . We want doctors to advise patients to take healthy lifestyle changes seriously and do the best they can. Certainly, we prefer to achieve blood pressure goals without adding medications; however, successful blood pressure treatment High blood pressure prolongs the years and quality of life.
