Review Article

Guidelines that are just for guidance

Swethika Sundaravel*, Jonathan Nieves and Seth Baum

Published: 09 April, 2018 | Volume 2 - Issue 1 | Pages: 031-037

Hypertension (HTN) is a widely prevalent disease across the globe. Recent reports from National Health and Nutrition Examination Surveys (NHANES) indicate that the prevalence of HTN is 29% in adults more than 18 years in the US [1]. This is about 72 million adults. Worldwide, about 1.3 billion people are affected by HTN [2]. This number is projected to increase several-fold in the coming years. Given the huge burden of this disease to the healthcare system and the many deleterious effects that can result from uncontrolled HTN, we need strong guidelines to manage the same. The recently published 2017 ACC/AHA guidelines [3] on hypertension management are very meticulous and include a comprehensive stepwise approach in treating hypertension. Here we present a summary of the major changes and a concise review of the new guidelines.

Read Full Article HTML DOI: 10.29328/journal.ach.1001009 Cite this Article Read Full Article PDF


  1. Cheryl D. Fryar, Yechiam Ostchega, Craig M. Hales, Guangyu Zhang, Deanna Kruszon-Moran. Hypertension Prevalence and Control among Adults: United States, 2015-2016. NCHS Data Brief No. 289. 2017. Ref.: https://goo.gl/rLMioj
  2. Michael J. Bloch. Worldwide prevalence of hypertension exceeds 1.3 billion. Journal of the American Society of Hypertension. 2016; 10: 753-754. Ref.: https://goo.gl/xPou25
  3. Whelton PK, Robert Carey M, Wilbert Aronow S, Donald Casey E, Karen Collins J, et al. ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. 2017 High Blood Pressure Clinical Practice Guideline. 2017. Ref.: https://goo.gl/cza7TM
  4. Aram V. Chobanian, George L. Bakris and the National High Blood Pressure Education Program Coordinating Committee. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003; 42: 1206-1252. Ref.: https://goo.gl/Qzx9RS
  5. Paul A. James, Suzanne Oparil, Barry L. Carter. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults Report from the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014; 311: 507-520. Ref.: https://goo.gl/PSAeNN
  6. Muntner P, Carey RM, Gidding S, Jones DW, Taler SJ, et al. Potential US population impact of the 2017 ACC/AHA high blood pressure guideline. Circulation. 2018; 137: 109-118. Ref.: https://goo.gl/P3unf8
  7. Fagard RH, Cornelissen VA. Incidence of cardiovascular events in white-coat, masked and sustained hypertension versus true normotension: a meta-analysis. J Hypertens. 2007; 25: 2193-2198. Ref.: https://goo.gl/5bqkGM
  8. Piper MA, Evans CV, Burda BU, Margolis KL, O'Connor E, et al. Diagnostic and predictive accuracy of blood pressure screening methods with consideration of rescreening intervals: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2015; 162: 192-204. Ref.: https://goo.gl/crDByQ
  9. Bayo J, Cos FX, Roca C, Dalfó A, Martín-Baranera MM, et al. Home blood pressure self-monitoring: diagnostic performance in white-coat hypertension. Blood Press Monit. 2006; 11: 47-52. Ref.: https://goo.gl/pJ1BPe
  10. SPRINT Research Group, Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015; 373: 2103-2116. Ref.: https://goo.gl/gpXUo9
  11. Warwick J, Falaschetti E, Rockwood K, Mitnitski A, Thijs L, et al. No evidence that frailty modifies the positive impact of antihypertensive treatment in very elderly people: an investigation of the impact of frailty upon treatment effect in the HYpertension in the Very Elderly Trial (HYVET) study, a double-blind, placebo-controlled study of antihypertensives in people with hypertension aged 80 and over. BMC Med. 2015; 13: 78. Ref.: https://goo.gl/nEZntP
  12. Williamson JD, Supiano MA, Applegate WB, Berlowitz DR, Campbell RC, et al. Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged ≥75 years: a randomized clinical trial. JAMA. 2016; 315: 2673-2682. Ref.: https://goo.gl/VwuA22
  13. Steven Tringali,Charles William Oberer, Jian Huang. Low Diastolic Blood Pressure as a Risk for All-Cause Mortality in VA Patients. Int J Hypertension. 2013; 2013. Ref.: https://goo.gl/JFNa3Y
  14. Xie X, Atkins E, Lv J, Bennett A, Neal B, et al. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis. Lancet. 2016; 387: 435-443. Ref.: https://goo.gl/Fm9wCG
  15. ACCORD Study Group, Cushman WC, Evans GW, Byington RP, Goff DC Jr, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010; 362: 1575-1585. Ref.: https://goo.gl/Yo2Ecr
  16. Stone NJ, Robinson J, Lichtenstein AH, Bairey Merz CN, Blum CB, et al. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014; 63: 2889-2934. Ref.: https://goo.gl/MGXmXw
  17. Cornelissen VA, Smart NA. Exercise training for blood pressure: a systematic review and meta-analysis. J Am Heart Assoc. 2013; 2: e004473. Ref.: https://goo.gl/wJ5pLF
  18. Carlson DJ, Dieberg G, Hess NC, Millar PJ, Smart NA. Isometric exercise training for blood pressure management: a systematic review and meta-analysis. Mayo Clin Proc. 2014; 89: 327-334. Ref.: https://goo.gl/XMBQFF
  19. Garcia-Hermoso A, Saavedra JM, Escalante Y. Effects of exercise on resting blood pressure in obese children: a meta-analysis of randomized controlled trials. Obes Rev. 2013; 14: 919-928. Ref.: https://goo.gl/dJXQNk
  20. Whelton PK, He J. Health effects of sodium and potassium in humans. Curr Opin Lipidol. 2014; 25: 75-79. Ref.: https://goo.gl/avJ8X7
  21. Carlberg B, Samuelsson O, Lindholm LH. Atenolol in hypertension: is it a wise choice? Lancet. 2004; 364: 1684-1689. Ref.: https://goo.gl/3dbN6D
  22. Kalkidan Bishu and Margaret M. Redfield. Acute Heart Failure with Preserved Ejection Fraction: Unique Patient Characteristics and Targets for Therapy. Curr Heart Fail Rep. 2013; 10. Ref.: https://goo.gl/dkGXA5
  23. Pfeffer MA, Claggett B, Assmann SF, Boineau R, Anand IS, et al. Regional variation in patients and outcomes in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial. Circulation. 2015; 131: 34-42. Ref.: https://goo.gl/96n4Wr
  24. Fraction Apostolos Tsimploulis, Phillip H. Lam, Cherinne Arundel, et al. Systolic Blood Pressure and Outcomes in Patients with Heart Failure with Preserved Ejection. JAMA Cardiol.
  25. Cross NB, Webster AC, Masson P, O'Connell PJ, Craig JC. Antihypertensive treatment for kidney transplant recipients. Cochrane Database Syst Rev. 2009; CD003598. Ref.: https://goo.gl/nKsZ9e
  26. Bavry AA, Anderson RD, Gong Y, Denardo SJ, Cooper-Dehoff RM, et al. Outcomes among hypertensive patients with concomitant peripheral and coronary artery disease: findings from the INternational VErapamil-SR/Trandolapril STudy. Hypertension 2010; 55: 48-53. Ref.: https://goo.gl/Xytj4P
  27. Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial Collaborative Research Group. Diuretic versus alpha-blocker as first-step antihypertensive therapy: final results from the Antihypertensive and LipidLowering Treatment to Prevent Heart Attack Trial (ALLHAT). Hypertension. 2003; 42: 239-246. Ref.: https://goo.gl/TnDUyv
  28. Emdin CA, Rahimi K, Neal B, Emdin CA, Rahimi K, Neal B, et al. Blood pressure lowering in type 2 diabetes: a systematic review and meta-analysis. JAMA. 2015; 313: 603-615. Ref.: https://goo.gl/ruUWgp
  29. Arguedas JA, Leiva V, Wright JM. Blood pressure targets for hypertension in people with diabetes mellitus. Cochrane Database Syst Rev. 2013; 10: CD008277. Ref.: https://goo.gl/XQspJW
  30. Wachtell K, Lehto M, Gerdts E, Olsen MH, Hornestam B, et al. Angiotensin II receptor blockade reduces new-onset atrial fibrillation and subsequent stroke compared to atenolol: the Losartan Intervention for End Point Reduction in Hypertension (LIFE) study. J Am Coll Cardiol. 2005; 45: 712-719. Ref.: https://goo.gl/k527KL
  31. Julius S, Kjeldsen SE, Weber M, Brunner HR, Ekman S, et al. Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial. Lancet. 2004; 363: 2022- 2031. Ref.: https://goo.gl/SLTGSf
  32. Devereaux PJ, Yang H, Yusuf S, Guyatt G, Leslie K, et al. Effects of extended-release metoprolol succinate in patients undergoing noncardiac surgery (POISE trial): a randomised controlled trial. POISE Study Group. Lancet. 2008; 371: 1839-1847. Ref.: https://goo.gl/2a1ZrD

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More