Hypertension Update 2018

This issue will bring you up to date on the recent guidelines for the management of hypertension in adults.

Key Takeaways:
• Two guidelines, two definitions of hypertension: The 2017 ACC/AHA guideline defines stage 1 hypertension as a BP of 130/80 mmHg or above. In contrast, the hypertension guideline from the 8th Joint National Committee (JNC 8) defines hypertension as BP of 140/90 mmHg or above - an ongoing controversy.
• Think preventive: ACC/AHA recommends lifestyle changes for patients with "elevated" BP and those with stage 1 hypertension who have a 10-year cardiovascular risk less than 10%.
• First Line Treatments: Both JNC 8 and ACC/AHA recommend thiazide-type diuretics (TTDs), angiotensin converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and calcium channel blockers (CCBs) as first line drug options.

Hypertension is a leading cause of cardiovascular disease, stroke, heart failure, and kidney disease. According to a recent update from the CDC National Center for Health Statistics, nearly 30% of adults in the US have hypertension. The rate of hypertension is similar among women (28%) and men (30%). It is more common among US non-hispanic black adults than any other ethnicity. Within age groups, the incidence ranges from 7.5% among adults 18-39 years old to 63% in those age 60 and older. Of concern is that hypertension control has not been improving. In 2015-2016, only 48% of adults with hypertension had achieved control which, at the time, was considered blood pressure less than 140/90 mmHg.

Recently, the American College of Cardiology (ACC) and the American Heart Association (AHA) released an updated guideline for the prevention, detection, evaluation and management of hypertension.2 The 2017 ACC/AHA guideline was developed and approved in collaboration with 9 other professional groups, including the American Pharmacists Association (APhA). A multidisciplinary, team-based approach to hypertension management is strongly recommended (including the patient, primary provider, and other professionals such as cardiologists, nurses, physician assistants, pharmacists, and dietitians)...