Perspective From Sweden on the Global Impact of the 2017 American College of Cardiology/American Heart Association Hypertension Guidelines
A “Sprint” Beyond Evidence in the United States
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The 2017 US hypertension guidelines1 define hypertension as blood pressure (BP) ≥130/80 mm Hg. Treatment should start with nonpharmacological intervention, followed by combined drug treatment, if needed. Primary drugs are thiazide or thiazide-type diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and both dihydropyridine and nondihydropyridine types of calcium channel blockers. β-Blockers are not first-line drugs, unless the patient has ischemic heart disease or heart failure, which makes sense.2 The new target is BP <130/80 mm Hg for most people. In those aged ≥65 years, the target is based on systolic blood pressure (SBP) (<130 mm Hg) only, which, again, is reasonable.3 The guideline committee should be commended for emphasizing how to measure BP and for clearly describing how to diagnose hypertension. Indeed, moving toward home BP measurements should increase people’s knowledge of their cardiovascular risk and could also increase compliance.
However, a stunning 46% of US adults have hypertension when the new practice guidelines are applied to the 2011 to 2014 National Health and Nutrition Examination Survey; 76% in the age group 65 to 74 years and 82% of those aged ≥75 years. One could almost say that, to avoid hypertension …