Guideline high blood pressure
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Summary
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These studies suggest the 2017 ACC/AHA High Blood Pressure Guideline recommends a BP target of 130/80 mm Hg for adults, emphasizes lowering blood pressure to reduce cardiovascular risk, and promotes self-monitoring and adherence to treatment.
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Guideline for High Blood Pressure Management
Introduction to High Blood Pressure Guidelines
High blood pressure, or hypertension, is a significant health concern globally, leading to severe cardiovascular diseases (CVD) and other health complications. The 2017 American College of Cardiology (ACC) and American Heart Association (AHA) guidelines provide a comprehensive framework for the prevention, detection, evaluation, and management of high blood pressure in adults .
Classification and Diagnosis of Hypertension
Blood Pressure Classification
The 2017 guidelines introduced a new classification system for blood pressure (BP). Normal BP is defined as systolic BP (SBP) less than 120 mm Hg and diastolic BP (DBP) less than 80 mm Hg. The term "prehypertension" was replaced with "elevated BP," defined as SBP of 120-129 mm Hg and DBP less than 80 mm Hg. Stage 1 hypertension is now defined as SBP of 130-139 mm Hg or DBP of 80-89 mm Hg, and stage 2 hypertension as SBP of at least 140 mm Hg or DBP of at least 90 mm Hg .
Measurement of Blood Pressure
Accurate BP measurement is crucial for proper diagnosis and management. The guidelines recommend using an average of at least two readings obtained on two separate occasions. Out-of-office BP measurements, such as ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM), are encouraged to confirm the diagnosis and manage treatment, especially to detect white coat hypertension and masked hypertension .
Management Strategies
Nonpharmacologic Interventions
Lifestyle modifications are the first line of treatment for individuals with elevated BP and stage 1 hypertension without CVD or a high risk of CVD. Recommended lifestyle changes include dietary modifications, increased physical activity, weight loss, and reduced sodium intake .
Pharmacologic Treatment
For patients with stage 1 hypertension and existing CVD or high CVD risk, and for all patients with stage 2 hypertension, antihypertensive medication is recommended. First-line medications include thiazide diuretics, calcium channel blockers (CCBs), angiotensin-converting enzyme inhibitors (ACEIs), and angiotensin receptor blockers (ARBs) .
Blood Pressure Targets
The guidelines recommend a BP target of less than 130/80 mm Hg for most adults, including those with CVD, chronic kidney disease (CKD), and diabetes mellitus. This target is based on evidence suggesting that lower BP reduces the risk of CVD events .
Special Populations
Older Adults
For adults aged 60 years or older, the guidelines suggest a target SBP of less than 150 mm Hg, although a lower target of 140 mm Hg may be appropriate for some individuals based on their overall health and risk factors .
Children and Adolescents
The 2017 guidelines for children and adolescents align with adult guidelines, simplifying BP classification and emphasizing the importance of annual BP screening during preventive care visits. The guidelines also recommend ABPM for diagnosing and managing pediatric hypertension .
Conclusion
The 2017 ACC/AHA guidelines provide a detailed and evidence-based approach to managing high blood pressure, emphasizing accurate measurement, lifestyle modifications, and appropriate pharmacologic treatment. These guidelines aim to reduce the prevalence of hypertension and its associated health risks, ultimately improving patient outcomes.
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