Global Impact of the 2017 American College of Cardiology/American Heart Association Hypertension Guidelines
A Perspective From Italy
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The 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guidelines1 have several important elements of novelty, and some weaknesses, as well. One strength is that, unlike the most recent US hypertension guidelines (the Joint National Commission 8 guidelines), the ACC/AHA document does not cover only a few items, eg, blood pressure (BP) threshold and target for treatment, but rather it deals with multiple aspects of hypertension diagnosis and treatment that, although unaddressed or nonaddressable by randomized clinical trials, have major importance for clinical practice. Another is that each issue is synthetically and clearly discussed in terms of its scientific evidence (thereby fulfilling the guidelines’ educational role) while still providing simple conclusions and recommendations according to a format that resembles the one used in the European Society of Hypertension/European Society of Cardiology guidelines.2 However, the new guidelines discuss the available evidence in a manner that is more complete than that used by the European and other guidelines, because it includes the level and strength of evidence for a given intervention, separating those which do not provide benefits from those which may cause harm.
The ACC/AHA guidelines take a strong position in favor of 3 major changes in antihypertensive …