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New High Blood Pressure Guidelines: Back on Track With Lower Treatment Goals, but Implementation Challenges Abound
The recently released 2017 High Blood Pressure Guidelines depart from past guidelines in both their approach and recommendations. Developed by multiple health organizations, including the American College of Preventive Medicine, the guidelines continue to define normal blood pressure as
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| Published in: | American journal of preventive medicine 2018-10, Vol.55 (4), p.575-578 |
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| Format: | Article |
| Language: | English |
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| cited_by | cdi_FETCH-LOGICAL-c390t-6af81e4c266b1fb352a8eea91b15835517cfe4fab630439bce513afdef9bc2623 |
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| cites | cdi_FETCH-LOGICAL-c390t-6af81e4c266b1fb352a8eea91b15835517cfe4fab630439bce513afdef9bc2623 |
| container_end_page | 578 |
| container_issue | 4 |
| container_start_page | 575 |
| container_title | American journal of preventive medicine |
| container_volume | 55 |
| creator | Stafford, Randall S. |
| description | The recently released 2017 High Blood Pressure Guidelines depart from past guidelines in both their approach and recommendations. Developed by multiple health organizations, including the American College of Preventive Medicine, the guidelines continue to define normal blood pressure as |
| doi_str_mv | 10.1016/j.amepre.2018.04.023 |
| format | article |
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Developed by multiple health organizations, including the American College of Preventive Medicine, the guidelines continue to define normal blood pressure as <120/80 mmHg, but now define hypertension as ≥130/80 mmHg (previously ≥140/90 mmHg). This change categorizes 101 million Americans (46% of adults) as hypertensive (compared to 32% previously). The guidelines rely heavily on findings from the Systolic Blood Pressure Intervention Trial (SPRINT). This clinical trial demonstrated substantial reductions in key adverse outcomes from intensive blood pressure management (goal systolic blood pressure <120 mmHg) compared to standard treatment (<140 mmHg). The guidelines emphasize non-drug strategies for blood pressure management, particularly healthy diet, several forms of physical activity, reduction in sodium intake, enhancement of potassium intake, reduction in alcohol use, and weight loss. A risk-based approach is recommended for drug therapy. Individuals with an elevated 10-year risk of future cardiovascular disease events should receive drug therapies for blood pressures ≥130/80 mmHg, whereas those at lower risk should receive antihypertensive medications for blood pressures ≥140/90 mmHg. Given that high blood pressure is poorly managed even with easier-to-reach goals, effective implementation of the guidelines will present significant challenges. The guidelines suggest that successful implementation requires the adoption of new models of chronic disease care, including team-based care, telehealth, a shift towards self-management, better approaches to patient adherence, and use of home blood pressure monitoring. Attention to systems level issues is much needed, including population-based management, aligned financial incentives, improved health literacy, community interventions, and improved access to primary care and medications.</description><identifier>ISSN: 0749-3797</identifier><identifier>EISSN: 1873-2607</identifier><identifier>DOI: 10.1016/j.amepre.2018.04.023</identifier><identifier>PMID: 30093159</identifier><language>eng</language><publisher>Netherlands: Elsevier Inc</publisher><subject>Alcohol use ; Antihypertensives ; Blood pressure ; Cardiovascular disease ; Cardiovascular diseases ; Chronic illnesses ; Clinical research ; Clinical trials ; Diet ; Drug therapy ; Financial incentives ; Health care industry ; Health literacy ; Hypertension ; Intervention ; Medical treatment ; Physical activity ; Primary care ; Risk reduction ; Selfmanagement ; Sodium ; Teams ; Telemedicine</subject><ispartof>American journal of preventive medicine, 2018-10, Vol.55 (4), p.575-578</ispartof><rights>2018 American Journal of Preventive Medicine</rights><rights>Copyright © 2018 American Journal of Preventive Medicine. 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Oct 2018</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c390t-6af81e4c266b1fb352a8eea91b15835517cfe4fab630439bce513afdef9bc2623</citedby><cites>FETCH-LOGICAL-c390t-6af81e4c266b1fb352a8eea91b15835517cfe4fab630439bce513afdef9bc2623</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925,30999</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30093159$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Stafford, Randall S.</creatorcontrib><title>New High Blood Pressure Guidelines: Back on Track With Lower Treatment Goals, but Implementation Challenges Abound</title><title>American journal of preventive medicine</title><addtitle>Am J Prev Med</addtitle><description>The recently released 2017 High Blood Pressure Guidelines depart from past guidelines in both their approach and recommendations. Developed by multiple health organizations, including the American College of Preventive Medicine, the guidelines continue to define normal blood pressure as <120/80 mmHg, but now define hypertension as ≥130/80 mmHg (previously ≥140/90 mmHg). This change categorizes 101 million Americans (46% of adults) as hypertensive (compared to 32% previously). The guidelines rely heavily on findings from the Systolic Blood Pressure Intervention Trial (SPRINT). This clinical trial demonstrated substantial reductions in key adverse outcomes from intensive blood pressure management (goal systolic blood pressure <120 mmHg) compared to standard treatment (<140 mmHg). The guidelines emphasize non-drug strategies for blood pressure management, particularly healthy diet, several forms of physical activity, reduction in sodium intake, enhancement of potassium intake, reduction in alcohol use, and weight loss. A risk-based approach is recommended for drug therapy. Individuals with an elevated 10-year risk of future cardiovascular disease events should receive drug therapies for blood pressures ≥130/80 mmHg, whereas those at lower risk should receive antihypertensive medications for blood pressures ≥140/90 mmHg. Given that high blood pressure is poorly managed even with easier-to-reach goals, effective implementation of the guidelines will present significant challenges. The guidelines suggest that successful implementation requires the adoption of new models of chronic disease care, including team-based care, telehealth, a shift towards self-management, better approaches to patient adherence, and use of home blood pressure monitoring. Attention to systems level issues is much needed, including population-based management, aligned financial incentives, improved health literacy, community interventions, and improved access to primary care and medications.</description><subject>Alcohol use</subject><subject>Antihypertensives</subject><subject>Blood pressure</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular diseases</subject><subject>Chronic illnesses</subject><subject>Clinical research</subject><subject>Clinical trials</subject><subject>Diet</subject><subject>Drug therapy</subject><subject>Financial incentives</subject><subject>Health care industry</subject><subject>Health literacy</subject><subject>Hypertension</subject><subject>Intervention</subject><subject>Medical treatment</subject><subject>Physical activity</subject><subject>Primary care</subject><subject>Risk reduction</subject><subject>Selfmanagement</subject><subject>Sodium</subject><subject>Teams</subject><subject>Telemedicine</subject><issn>0749-3797</issn><issn>1873-2607</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>7QJ</sourceid><recordid>eNp9kcFu1DAQhq2qqF1K36BClnrhQMLYTuK4B6R2BdtKK-BQxNFynEnXSxJv7YSKt8erLRx64OTR6PvHo_kIuWCQM2DVh21uBtwFzDmwOociBy6OyILVUmS8AnlMFiALlQmp5Cl5HeMWAGTN1Ak5FQBKsFItSPiCT_TWPWzoTe99S78FjHEOSFeza7F3I8YremPsT-pHeh_2xQ83bejaP2FIDTTTgONEV9708T1t5oneDbse900zuRRabkzf4_iAkV43fh7bN-RVl2A8f37PyPfPn-6Xt9n66-pueb3OrFAwZZXpaoaF5VXVsK4RJTc1olGsYWUtypJJ22HRmaYSUAjVWCyZMF2LXap5xcUZeXeYuwv-ccY46cFFi31vRvRz1BxqWSrBQST08gW69XMY03aas3TRWoFkiSoOlA0-xoCd3gU3mPBbM9B7J3qrD0703omGQicnKfb2efjcDNj-C_2VkICPBwDTNX45DDpah6PF1gW0k269-_8PfwBTRJ74</recordid><startdate>201810</startdate><enddate>201810</enddate><creator>Stafford, Randall S.</creator><general>Elsevier Inc</general><general>Elsevier Science Ltd</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>7X8</scope></search><sort><creationdate>201810</creationdate><title>New High Blood Pressure Guidelines: Back on Track With Lower Treatment Goals, but Implementation Challenges Abound</title><author>Stafford, Randall S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c390t-6af81e4c266b1fb352a8eea91b15835517cfe4fab630439bce513afdef9bc2623</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Alcohol use</topic><topic>Antihypertensives</topic><topic>Blood pressure</topic><topic>Cardiovascular disease</topic><topic>Cardiovascular diseases</topic><topic>Chronic illnesses</topic><topic>Clinical research</topic><topic>Clinical trials</topic><topic>Diet</topic><topic>Drug therapy</topic><topic>Financial incentives</topic><topic>Health care industry</topic><topic>Health literacy</topic><topic>Hypertension</topic><topic>Intervention</topic><topic>Medical treatment</topic><topic>Physical activity</topic><topic>Primary care</topic><topic>Risk reduction</topic><topic>Selfmanagement</topic><topic>Sodium</topic><topic>Teams</topic><topic>Telemedicine</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Stafford, Randall S.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of preventive medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Stafford, Randall S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>New High Blood Pressure Guidelines: Back on Track With Lower Treatment Goals, but Implementation Challenges Abound</atitle><jtitle>American journal of preventive medicine</jtitle><addtitle>Am J Prev Med</addtitle><date>2018-10</date><risdate>2018</risdate><volume>55</volume><issue>4</issue><spage>575</spage><epage>578</epage><pages>575-578</pages><issn>0749-3797</issn><eissn>1873-2607</eissn><abstract>The recently released 2017 High Blood Pressure Guidelines depart from past guidelines in both their approach and recommendations. Developed by multiple health organizations, including the American College of Preventive Medicine, the guidelines continue to define normal blood pressure as <120/80 mmHg, but now define hypertension as ≥130/80 mmHg (previously ≥140/90 mmHg). This change categorizes 101 million Americans (46% of adults) as hypertensive (compared to 32% previously). The guidelines rely heavily on findings from the Systolic Blood Pressure Intervention Trial (SPRINT). This clinical trial demonstrated substantial reductions in key adverse outcomes from intensive blood pressure management (goal systolic blood pressure <120 mmHg) compared to standard treatment (<140 mmHg). The guidelines emphasize non-drug strategies for blood pressure management, particularly healthy diet, several forms of physical activity, reduction in sodium intake, enhancement of potassium intake, reduction in alcohol use, and weight loss. A risk-based approach is recommended for drug therapy. Individuals with an elevated 10-year risk of future cardiovascular disease events should receive drug therapies for blood pressures ≥130/80 mmHg, whereas those at lower risk should receive antihypertensive medications for blood pressures ≥140/90 mmHg. Given that high blood pressure is poorly managed even with easier-to-reach goals, effective implementation of the guidelines will present significant challenges. The guidelines suggest that successful implementation requires the adoption of new models of chronic disease care, including team-based care, telehealth, a shift towards self-management, better approaches to patient adherence, and use of home blood pressure monitoring. 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| fulltext | fulltext |
| identifier | ISSN: 0749-3797 |
| ispartof | American journal of preventive medicine, 2018-10, Vol.55 (4), p.575-578 |
| issn | 0749-3797 1873-2607 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2087593203 |
| source | Applied Social Sciences Index & Abstracts (ASSIA); ScienceDirect Freedom Collection 2022-2024 |
| subjects | Alcohol use Antihypertensives Blood pressure Cardiovascular disease Cardiovascular diseases Chronic illnesses Clinical research Clinical trials Diet Drug therapy Financial incentives Health care industry Health literacy Hypertension Intervention Medical treatment Physical activity Primary care Risk reduction Selfmanagement Sodium Teams Telemedicine |
| title | New High Blood Pressure Guidelines: Back on Track With Lower Treatment Goals, but Implementation Challenges Abound |
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