By Eduardo Gonzales, MD
I read a news item that experts have redefined hypertension. Is this true? —firstname.lastname@example.org
Yes, that’s true. The American College of Cardiology (ACC) and the American Heart Association (AHA) have recently released their new “Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults,” which, among other things, literally re-defined hypertension. This 2017 guideline is an update of a similar document published in 2003. It is a voluminous document that was drawn up by a group of experts after an extensive review of data from numerous studies regarding the role of blood pressure (BP) in cardiovascular disease (CVD).
New Definition of Hypertension
The new guideline lowered the threshold for hypertension to 130 over 80 from the previous 140 over 90. Under the new blood-pressure classification system, blood pressure (BP) should be categorized as follows:
To categorize a person into any category, it is important to use an average based on ≥2 readings obtained on ≥2 occasions. Out-of-office and self-monitoring of BP measurements are also recommended to confirm the diagnosis of hypertension.
New guideline will dramatically increase the number of Filipinos with hypertension
Using the old guideline, according to our Department of Health (DOH), about 12 million Filipinos are hypertensive. This number will balloon to at least 15 million if the new guideline is applied, half of whom are “walking time bombs” because they are unaware of (hypertension is a symptomless condition) or choose to ignore their condition. Hypertension accounts directly or indirectly for about 200,000 deaths every year in the Philippines. It is also the third leading cause of morbidity (2014 figures) in our country behind respiratory infections and pneumonia.
Benefit and implications on treatment of the new guideline
The new guideline is better than the previous one in that it alerts people on the dangers of hypertension earlier, which allows interventions to start sooner. Thus, people in the elevated blood pressure category will already be treated with non-pharmacologic measures (i.e., adopt certain lifestyle changes) to lower their risk of becoming hypertensive and developing cardiovascular disease whereas before, these people’s BP is considered normal and does not warrant any intervention.
While more people will be labeled hypertensive using the new definition, not all of them will be required to take medications. The guideline recommends medication for Stage I hypertension only if a patient has already had a cardiovascular event such as a heart attack or stroke, or if the patient is at high risk of heart attack or stroke based on age, the presence of diabetes, chronic kidney disease or risk of plaque in the arteries. All others will simply be advised to adopt the lifestyle changes recommended for people with elevated blood pressure and to monitor their blood pressure.
Adults with stage 2 hypertension, on the other hand, should be treated with antihypertensive drugs in addition to lifestyle changes, while those who fall into the hypertensive crisis category should see their doctor immediately.
For adults with confirmed hypertension but without any additional risk factor for cardiovascular disease, a BP target of <130/80 mm Hg is reasonable.
Lifestyle interventions for people with elevated blood pressure and hypertension
Lifestyle or non-pharmacological measures for people with BP issues include non-smoking, exercise, weight loss for overweight people, healthy diet, reduced sodium intake, enhanced intake of dietary potassium, stress management measures such as enough sleep, recreation, meditation and relaxation techniques, and moderate alcohol intake—men should be limited to no more than two and women no more than one standard alcohol drink(s) per day.
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