In stage 1 hypertension, medication feasible if BP goal not met after lifestyle changes
In an update to the 2017 hypertension guideline, the American Heart Association recommended lifestyle changes for patients with slightly elevated BP, adding medication if necessary after 6 months.
“It’s important to control BP to goal in all people, and in those who have stage 1 hypertension who can’t meet goal blood pressure with lifestyle therapy only, medication should be considered,” Daniel W. Jones, MD, FAHA, professor and dean emeritus of the University of Mississippi School of Medicine and past president of the AHA, told Healio.
In a scientific statement from the AHA published in Hypertension, researchers recommended treatment with medication for people with stage 1 hypertension (130-139/80-89 mm Hg) if treatment goals were not met after 6 months of sustained healthy lifestyle adjustments.
According to the researchers, the 2017 American College of Cardiology/AHA Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults recommended lifestyle therapy for adults with stage 1 hypertension and a 10-year risk for CVD less than 10% and suggested that BP measurement be repeated at 3-to-6-month intervals, but offered no further guidance.
“For many years we have been focused on 140/90 mm Hg, and so it’s difficult for clinicians now to change their thinking to think between 130 mm Hg and 140 mm Hg. I’d need to be paying attention to try and help the patient to get their blood pressure lower than that, to below 130 mm Hg,” Jones said in an interview.
Jones noted that the guideline committees are constrained by what kind of evidence can be used and that guideline writers are constrained to use only randomized controlled trials data to give their recommendations.
“The recommendations in the 2017 AHA/ACC guidelines are to check the 10-year CVD risk and if that risk is greater than 10%, then for all BP above 130/80 mm Hg medication plus lifestyle therapy should be implemented,” Jones said in an interview.
According to the researchers, elevated BP in younger patients was associated with arterial stiffness in adulthood as measured by pulse wave velocity (OR = 1.83; 95% CI, 1.39-2.4), carotid intima-media thickness (OR = 1.6; 95% CI, 1.29-2) and left ventricular hypertrophy (OR = 1.4; 95% CI, 1.2-1.64).
“For a number of years, we have been very focused on 10-year risk. If you are dealing with a 60-year-old person, 10-year risk means something in the calculation. But when you are dealing with a 30-year-old person who has a blood pressure in 130 mm Hg to 140 mm Hg range, the risk for an event in 10 years is low. But we know that left untreated, the blood pressure will continue to rise with age and the damage from the blood pressure begins at that low blood pressure and at that young age. We need a randomized controlled trial in young patients with low 10-year risk but high lifetime risk,” Jones said in an interview.
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Daniel W. Jones, MD, FAHA, can be reached at email@example.com.