Hypertension Guidelines

Extract

How the recent 2017 American Guidelines for hypertension in adults differ from the 2013 ESH/ESC Guidelines 

At the last meeting of the American Heart Association (AHA) in November 2017, the new 2017 High Blood Pressure Clinical Practice Guidelines produced by the American College of Cardiology (ACC) and AHA were presented. They were published simultaneously in Hypertension and in the Journal of the American College of Cardiology.¹ These new recommendations provide major conceptual changes when compared to JNC7 guidelines or the JNC8 committee report.

In the present analysis, we shall discuss the rather major differences between 2017 ACC/AHA guidelines and those published by the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH) in 2013,² knowing that these two latter societies will provide revised recommendations in 2018.

The major differences concern:

...

Let’s examine these differences point by point:

1. A new classification for hypertension

The biggest change of the 2017 ACC/AHA guidelines is the revision of the BP categories in hypertension. Figure 1 illustrated these differences. In contrast to all previous international guidelines the normal BP is set at <120/80 mmHg and hypertension Stage 1 starts at BP levels above 130/80 mmHg rather than 140/90 mmHg as in actual European guidelines. Of note, in the ACC/AHA classification, there is no Stage 3 and the concept of isolated systolic hypertension, as mostly observed in elderly patients has disappeared. In fact, there is no mention of isolated systolic hypertension across the 2017 ACC/AHA document.