SAN DIEGO—The first practice changer is with the diagnosis of hypertension, began Leslie L. Davis, PhD, RN, ANP-BC, FAANP, FPCNA, FAHA. “The 2017 American Heart Association/American College of Cardiology guidelines1 show us that Stage 1 hypertension is now 130 to 139 mm Hg systolic, and that has always been traditionally 140 mm Hg and above, so this dramatically changes how we diagnose and treat hypertension.”
“That means that another 14% or so of Americans will now fall under the category of Stage 1 hypertension. It doesn’t mean that all of these people will be on medication; however, when we reclassify, that’s a big chunk of the population. We go from about 32% prevalence to about 46% of adults in the United States having hypertension,” Davis said during a presentation at the annual Cardiology, Allergy, and Respiratory Disease Summit.
According to the guidelines, normal blood pressure (BP) is now <120 mm Hg systolic and <80 mm Hg diastolic. Elevated BP is 120 to 129 mm Hg systolic and <80 mm Hg diastolic. And Stage 2 hypertension is ≥140 mm Hg systolic and ≥90 mm Hg diastolic.
“This means we need to be a little more vigilant about screening and about getting patients in the system a little sooner . . . and potentially about making some critical lifestyle changes because we know that blood pressure over time in men and women will gradually go up,” Davis said at the conference, held by Global Academy for Medical Education. “Systolic and diastolic blood pressure increases every year of life on average, and by the fifth decade of life, diastolic will start going down, but systolic will continue to increase. If we can catch folks sooner, we can prevent the poor outcomes associated with having hypertension,” she stated.
Numbers matter
The new guidelines, Davis continued, mean that “more than ever, accuracy in blood pressure measurement really matters.” She said, "It’s essential to take accurate blood pressures,” and to pay attention to things like having patients in a sitting position, at rest, with both feet planted on a flat surface, with back supported, and with arm at heart level for at least 5 minutes when taking BP measurements; to remove constrictive clothing and not just push it up; to make sure the patient hasn’t used caffeine or tobacco for at least 30 minutes prior to the measurement; to use the correct size sphygmomanometer cuff; to have the patient not talk during the measurement; and to consider out-of-office BP measurements in the overall assessment.
"We might have been late in the game in my opinion in the United States of really pushing this issue of using blood pressures from other settings—not just using in-office blood pressure readings,” Davis said making the point that the European and Canadian guidelines incorporated BP readings from other settings in the recommendations for diagnosing hypertension about 5 years ago.
“We need more than just the blood pressure readings we’re getting in the office,” she said, to identify things like white coat hypertension and masked hypertension, which is the opposite of white coat hypertension, meaning a patient’s BP is within normal limits in the office or clinic, but elevated when he/she is away from a medical setting.
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