The 2017 hypertension guidelines from the American College of Cardiology and American Heart Association (ACC/AHA) recommend everyone with hypertension aim for a persistent blood pressure (BP) of less than 130/80 mm Hg.1 The exception is for people age 65 and older. The guidelines only specify a systolic BP less than 130 mm Hg. This is a significant change from the 2014 guidelines which set BP goals of less than 150/90 mm Hg for people age 60 and older and less than 140/90 mm Hg for people under age 60.2
The expert panel determined that lower treatment thresholds and targets will benefit patients sooner and potentially prevent more blood pressure-related complications, such as heart attack, heart failure, and stroke.1,3-5 The systematic review and meta-analysis performed for the 2017 hypertension guidelines looked at nine studies that compared a lower systolic blood pressure target of <130 mm Hg versus the standard blood pressure goal of <140/90 mm Hg.3 The authors determined that a lowered blood pressure goal significantly reduced the risk for myocardial infarction (relative risk [RR] 0.86, 95% confidence interval [CI] [0.76 – 0.99]), major cardiovascular events (RR 0.81, 95% CI [0.70 – 0.94]), stroke (RR 0.77, 95% CI [0.65 – 0.91]), and heart failure (RR: 0.75, 95% CI [0.56 – 0.99]). They found a marginally significant reduction in the risk for all-cause mortality (RR 0.89, 95% CI [0.77 – 1.02]). The beneficial effects of the lower blood pressure target appeared similar regardless of age or comorbid conditions.
References
- Whelton PK, Carey RM, Aronow WS, et al. 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: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2017.
- James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults. JAMA 2014; 311 (5): 507-520.
- Reboussin DM, Allen NB, Griswold ME, et al. Systematic review for the 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. J Am Coll Cardiol 2017.
- Cifu AS, Davis AM. Prevention, detection, evaluation, and management of high blood pressure in adults. JAMA 2017; 318 (21): 2132-2134.
- Wright JT, Jr., Williamson JD, Whelton PK, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 2015; 373 (22): 2103-2116.
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