2017 ACC/AHA BP Guideline

47 Pages·2017·2.73 MB·English

by  Whelton, Paul K

NEW GUIDELINES FOR
HYPERTENSION DIAGNOSIS
Suzanne Oparil, MD, FACC, FAHA, FASH, FAPS

Distinguished Professor of Medicine, Professor of Cell, Developmental and Integrative Biology
Director, Vascular Biology and Hypertension Program of the Division of Cardiovascular Disease
University of Alabama at Birmingham, Birmingham, Alabama
Past President, American Heart Association (AHA)
Past President, American Society of Hypertension (ASH)

Alabama Cardiovascular Health Network Quarterly Meeting
Alabama Department of Public Health
Cardiovascular and Diabetes Branch
Clanton, Alabama
Wednesday, December 6, 2017
2017 Guideline for the Management of Patients with Hypertension
INITIATIVE LEAD BY
 American College of Cardiology (ACC) FOLLOWS 2011 IOM RECOMMENDATIONS

 American Heart Association (AHA)

WRITING COMMITTEE

• Multidisciplinary (21 members)
NINE ADDITIONAL PARTNERS
• No relationships with industry
 American Academy of Physician Assistants

 American College of Preventive Medicine
PROCESSES STANDARDIZED
 American Geriatrics Society
• Recs supported by evidence tables
 American Pharmacists Association
• PICOT questions (ERC analysis)
 American Society of Hypertension • Rec interpretation (COR and LOE)
 American Society of Preventive Cardiology • Peer review (internal & external)
 Association of Black Cardiologists
ERC = Evidence Review Committee
 National Medical Association
COR = Class of Recommendation
 Preventive Cardiovascular Nurses
LOE = Level of Evidence
Association
2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA
Guideline for the Prevention, Detection, Evaluation and Management of
High Blood Pressure in Adults
A Report of the American College of Cardiology/American Heart Association
Task Force on Clinical Practice Guidelines
Whelton PK, et al. Hypertension. (2017). Originally published November 13, 2017. doi: https://doi.org/10.1161/HYP.0000000000000065

Whelton PK, et al. J Am Coll Cardiol. (2017). pii: S0735-1097(17)41519-1. doi: 10.1016/j.jacc.2017.11.006. [Epub ahead of print].
2017 High Blood Pressure Guideline Writing Committee

Paul K. Whelton, MB, MD, MSc, FAHA, Chair
Robert M. Carey, MD , FAHA, Vice Chair
W ilbert S. Aronow, MD, FACC, FAHA* Bruce Ovbiagele, MD, MSc, MAS, MBA,FAHA†
Donald E. Casey, Jr, MD, MPH, MBA, FAHA† Sidney C. Smith, Jr, MD, MACC, FAHA††
Karen J. Collins, MBA‡ Crystal C. Spencer, JD‡
Cheryl Dennison Himmelfarb, RN, ANP, PhD, FAHA§ Randall S. Stafford, MD, PhD‡‡
Sondra M. DePalma, MHS, PA-C, CLS, AACC║ Sandra J. Taler, MD, FAHA§§
Samuel Gidding, MD, FACC, FAHA¶ Randal J. Thomas, MD, MS, FACC, FAHA║║
Kenneth A. Jamerson, MD# Kim A. Williams, Sr, MD, MACC, FAHA†
Daniel W. Jones, MD, FAHA† Jeff D. Williamson, MD, MHS¶¶
Eric J. MacLaughlin, PharmD** Jackson T. Wright, Jr, MD, PhD, FAHA##
Paul Muntner, PhD, FAHA†

*American Society for Preventive Cardiology Representative. †ACC/AHA Representative.
‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association
Representative. ║American Academy of Physician Assistants Representative. ¶Task Force
Liaison. #Association of Black Cardiologists Representative. **American Pharmacists
Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American
College of Preventive Medicine Representative. §§American Society of Hypertension
Representative. ║║Task Force on Performance Measures Liaison. ¶¶American Geriatrics
Society Representative. ##National Medical Association Representative.
Applying Class of
Recommendation and Level of
Evidence to Clinical Strategies,
Interventions, Treatments, or
Diagnostic Testing
in Patient Care*
(Updated August 2015)
Systematic Review Questions on High BP in Adults
Question
Question
Number
1 Is there evidence that self-directed monitoring of BP and/or ambulatory BP monitoring
are superior to office-based measurement of BP by a healthcare worker for 1)
preventing adverse outcomes for which high BP is a risk factor and 2) achieving better
BP control?
2 What is the optimal target for BP lowering during antihypertensive therapy in adults?
3 In adults with hypertension, do various antihypertensive drug classes differ in their
comparative benefits and harms?
4 In adults with hypertension, does initiating treatment with antihypertensive
pharmacological monotherapy versus initiating treatment with 2 drugs (including fixed-
dose combination therapy), either of which may be followed by the addition of
sequential drugs, differ in comparative benefits and/or harms on specific health
outcomes?
BP indicates blood pressure.
2017 Guideline for the Prevention, Detection, Evaluation
and Management of High Blood Pressure in Adults
A comprehensive guideline that represents an update of
JNC 7, not the focused JNC 8 (2014 Guideline)

 Reclassification of high blood pressure
 BP treatment thresholds and ASCVD risk
 BP treatment goals
 Management of hypertension in patients with
comorbidities
 Recommendations for BP management in older adults
2017 Guideline for the Prevention, Detection, Evaluation
and Management of High Blood Pressure in Adults
BP Classification
(JNC 7 and ACC/AHA Guidelines)
SBP DBP JNC 7 2017 ACC/AHA
<120 and <80 Normal BP Normal BP
120–129 and <80 Prehypertension Elevated BP
130–139 or 80–89 Prehypertension Stage 1 hypertension
140–159 or 90-99 Stage 1 hypertension Stage 2 hypertension
≥160 or ≥100 Stage 2 hypertension Stage 2 hypertension
• Blood Pressure should be based on an average of ≥2 careful readings on ≥2 occasions
• Adults being treated with antihypertensive medication designated as having hypertension
Distribution of US adults into BP Categories – NHANES 2011-2014
50%
42.3%
Prevalence of hypertension: 45.6%
40%
30%
24.1%
20%
13.7%
12.1%
10% 7.7%
0%
<120/80 120-129/<80 130-139/80-89 >=140/90 Antihypertensive
medication use
Normal Elevated Stage 1 Stage 2
Hypertension Hypertension
Muntner et. al., JACC. 2017 (in press)
Muntner, et. al., Circulation. 2017 (in press)
Prevalence of Hypertension – 2017 ACC/AHA and JN7 Guidelines
Prevalence of hypertension, % Number with hypertension, millions
50% 120
45.6%
103.3
40%
90
31.9%
72.2
30%
60
20%
30
10%
0% 0
JNC7 guideline JNC7 guideline
2017 ACC/AHA guideline
2017 ACC/AHA guideline
Whelton PK et al. Hypertension. 2017 Muntner et. al. JACC. 2017
Whelton PK et al. JACC. 2017 Muntner, et. al. Circulation 2017