A brief commentary on the new recommendations for the treatment of hypertension in the US
2017 ACC/ AHA High Blood Pressure Guideline

Česká verzia

Authors: I. Řiháček
Authors place of work: II. interní klinika LF MU a FN U sv. Anny v Brně
Published in the journal: Kardiol Rev Int Med 2018, 20(1): 54-59

Summary

The new 2017 US Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults aims at updating the data from clinical trials and accentuates the previously underemphasized sections of the 2003 and 2013 reports. The new guideline quickly generated intense discussion and controversy. Unlike the previous guideline, it emphasizes individualized cardiovascular risk assessment, focuses on proper blood pressure measurement and encourages home blood pressure monitoring. It establishes a new definition of hypertension and new blood pressure goal according to the cardiovascular risk. The lower threshold for hypertension will expand the number of Americans with this diagnosis and increase the number of people who should be controlled and treated. This guideline evolved a new presentation format. Each modular includes a table of related recommendations, references to evidence, a brief synopsis and recommendations and specific text where appropriate. The references are provided within the modular chunk to facilitate quick review and electronic search.

Key words:
guideline – blood pressure – cardiovascular risk – definition of hypertension – treatment goal – controversy

Zdroje

1. 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. doi: 10.1161/ HYP.0000000000000065.

2. Wright JT jr, Williamson JD, Whelton PK et al. SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 2015; 373(22): 2103– 2116. doi: 10.1056/ NEJMoa1511939.

3. Mancia G, Fagard R, Narkiewicz K et al. 2013 ESH/ ESC Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013; 34(28): 2159– 2219. doi: 10.1093/ eurheartj/ eht15.

4. Widimský J, Filipovský J, Ceral J et al. Doporučení pro diagnostiku a léčbu arteriální hypertenze ČSH 2017. Hypertenze a kardiovaskulární prevence 2018; 7 (Suppl): 1–20.

5. Wilt TJ, Kansagare D, Qaseem A et al. Hypertension Limbo: balancing benefits, harms, and patient preferences before we lower the bar on blood pressure. Ann Intern Med 2018. doi: 10.7326/ M17-3293.

6. Lewington S, Clarke R, Qizilbash N et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360(9349): 1903– 1913.

7. Mancia G, De Backer G, Dominiczak A et al. 2007 Guidelines for the management of arterial hypertension. The task force for the management of hypertension of the European Society of Hypertension and of the European Society of Cardiology. Guidelines Committee. J Hypertens 2007; 25(6): 1105– 1187.

8. ASCVD Risk Estimator Plus. Available at: http:/ / tools.acc.org/ ascvd-risk-estimator-plus/ #!/ calculate/ estimate/ .

9. 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 Foundation/ American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2017; pii: S0735-1097(17)41517-8. doi: 10.1016/ j.jacc.2017.11.004.

10. Muntner P, Carey MR, Gidding S et al. Potential US population impact of the 2017 American College Cardiology/ American Heart Association high blood pressure guideline. Circulation 2018; 137(2): 109– 118. doi: 10.1161/ CIRCULATIONAHA.117.032582.

11. Cushman WC, Evans GW, Byington RP et al. ACCORD Study Group. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med 2010; 362(17): 1575– 1585. doi: 10.1056/ NEJMoa1001286.