2017 American College of Cardiology /American Heart Association Blood Pressure (BP) Guideline for Management of Hypertension

Since the release of the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) Blood Pressure (BP) Guideline, several significant findings related to the prevention, detection, and management of hypertension have emerged. It addresses various topics, including BP measurement, evaluation for secondary hypertension, cardiovascular disease (CVD) risk assessment, drug therapy thresholds, lifestyle and pharmacological management, treatment targets, and the management of hypertension in older adults, individuals with diabetes, and those with chronic kidney disease or resistant hypertension. The new insights in these areas aim to enhance awareness, treatment, and control of hypertension, which are crucial for preventing CVD and reducing mortality in the future.

The 2017 ACC/AHA Guidelines and other recent recommendations endorse the use of thiazide or thiazide-type diuretics, calcium channel blockers (CCBs), angiotensin-converting enzyme inhibitors (ACEIs), and angiotensin receptor blockers (ARBs) as primary medications for hypertension treatment, due to their proven effectiveness in lowering blood pressure (BP) and improving clinical outcomes. Beta-blockers are not typically recommended as first-line treatments for individuals without coronary heart disease (CHD) or heart failure, as they show less benefit in reducing stroke risk compared to other classes. For patients with resistant hypertension, spironolactone or eplerenone are suggested for BP management.

Chlorthalidone and indapamide, which are thiazide-like diuretics, are preferred over traditional thiazide diuretics because of their longer action.Certain glucose-lowering medications, particularly GLP-1 receptor agonists and SGLT-2 inhibitors, have been shown to improve cardiovascular and kidney health, especially in diabetic patients, and they also lower BP, with SGLT-2 inhibitors having the most significant effect. 

Key strategies for effective blood pressure management in adults with hypertension are:

• Collaborate on setting a blood pressure goal between the patient and healthcare provider.
• Implement fixed-dose combination medications.
• Prefer long-acting chlorthalidone over hydrochlorothiazide (or consider indapamide).
• Choose long-acting amlodipine as the first-line calcium channel blocker.
• Schedule monthly follow-ups until the target blood pressure is reached.
• If permissible, switch from 30-day to 90-day prescription refills.
• Utilize telehealth to support in-person management.
• Improve communication and feedback through enhanced connections among the patient, provider, and electronic health records.
• Assess social determinants of health and identify barriers to care.
• Adapt a multidisciplinary team approach to improve adherence to lifestyle changes and medication, as well as to address social challenges.

Source:Carey RM, Wright JT Jr, Taler SJ, Whelton PK. Guideline-Driven Management of Hypertension: An Evidence-Based Update. Circ Res. 2021 Apr 2;128(7):827-846. doi: 10.1161/CIRCRESAHA.121.318083. Epub 2021 Apr 1. PMID: 33793326; PMCID: PMC8034801.