Global Impact of the 2017 American College of Cardiology/American Heart Association Hypertension Guidelines
A Perspective From Canada
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The new American College of Cardiology/American Heart Association (ACC/AHA) hypertension guideline1 represents a comprehensive set of recommendations, raising the question of impact beyond the United States—for example, on Canadian physicians. A personal view as a hypertension specialist from Canada follows.
There are major novelties in the guideline, a surprise, and a possible omission. Novelties are (1) a new definition of hypertension (blood pressure [BP] ≥130/80 mm Hg) and its stages (stage 1, ≥130/80–139/89 mm Hg; stage 2, ≥140/90 mm Hg), and the replacement of prehypertension from the Joint National Committee 7 by elevated BP (systolic BP of 120–129 mm Hg); (2) new thresholds (≥130/80 mm Hg) and goals for treatment of most hypertensive patients (<130/80 mm Hg); (3) recommendations accompanied by Class of Recommendation and Level of Evidence; and (4) global risk considered for treatment decisions. The surprise is that there is no SPRINT (Systolic Blood Pressure Intervention Trial)–based recommendation for patients with high cardiovascular risk.2 In contrast, Hypertension Canada’s guidelines incorporated a SPRINT-based recommendation for these hypertensive individuals in 2016 (Table).3,4
The possible omission is that, whereas the guideline insists on accurate and standardized BP measurement, there is no recommendation regarding automated office BP (AOBP). AOBP is obtained with automatic BP …