2017 Guideline for the Prevention, Detection, Evaluation ...

1 2017 Guideline for the Prevention, Detection, Evaluation , and Management of High Blood Pressure in Adults GUIDELINES MADE SIMPLE. A Selection of Tables and Figure 2018, American College of Cardiology B18060. 2017 Guideline for the Prevention, Detection, Evaluation , and Management of High Blood Pressure in Adults A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines Writing Committee: Paul K. Whelton, MB, MD, MSc, FAHA, Chair Robert M. Carey, MD, FAHA, Vice Chair Wilbert S. Aronow, MD, FACC, FAHA. Donald E. Casey, Jr, MD, MPH, MBA, FAHA. Karen J. Collins, MBA. Cheryl Dennison Himmelfarb, RN, ANP, PhD, FAHA. Sondra M. DePalma, MHS, PA-C, CLS, AACC. Samuel Gidding, MD, FAHA. Kenneth A. Jamerson, MD. Daniel W. Jones, MD, FAHA. Eric J. MacLaughlin, PharmD. Paul Muntner, PhD, FAHA.

2 Bruce Ovbiagele, MD, MSc, MAS, MBA FAHA. Sidney C. Smith, Jr, MD, MACC, FAHA. Crystal C. Spencer, JD. Randall S. Stafford, MD, PhD. Sandra J. Taler, MD, FAHA. Randal J. Thomas, MD, MS, FACC, FAHA. Kim A. Williams, Sr, MD, MACC, FAHA. Jeff D. Williamson, MD, MHS. Jackson T. Wright, Jr, MD, PhD, FAHA. The ACC and AHA convened this writing committee to address the prevention, detection, Evaluation , and management of high blood pressure in adults. The first comprehensive Guideline for detection, Evaluation , and management of high BP was published in 1977, under the sponsorship of the NHLBI. In subsequent years, a series of Joint National Committee (JNC) BP guidelines were published to assist the practice community and improve prevention, awareness, treatment, and control of high BP. The present Guideline updates prior JNC reports. 2018, American College of Cardiology B18060.

3 The following resource contains Figures and Tables from the 2017 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. The resource is only an excerpt from the Guideline and the full publication should be reviewed for more figures and tables as well as important context. CITATION: J Am Coll Cardiol. Sep 2017, 23976; DOI: 2017 Guideline for the Prevention, Detection, Evaluation , and Management of High Blood Pressure in Adults GUIDELINES MADE SIMPLE. Selected Tables or Figure Page Categories of BP in Adults 4. Corresponding Values of Systolic BP/Diastolic BP for Clinic, Home (HBPM), Daytime, Nighttime, and 24-Hour Ambulatory (ABPM) Measurement 4. Detection of White Coat Hypertension or Masked Hypertension in Patients Not on Drug Therapy 5. Detection of White Coat Hypertension or Masked Hypertension in Patients on Drug Therapy 6.

4 Screening for Secondary Hypertension 7. Causes of Secondary Hypertension with Clinical Indications and Diagnostic Screening Tests (1 of 3) 8. Causes of Secondary Hypertension with Clinical Indications and Diagnostic Screening Tests (2 of 3) 9. Causes of Secondary Hypertension with Clinical Indications and Diagnostic Screening Tests (2 of 3) 10. Frequently Used Medications and Other Substances That May Cause Elevated BP 11. Best Proven Nonpharmacologic Interventions for Prevention and Treatment of Hypertension 12. Basic and Optional Laboratory Tests for Primary Hypertension 13. Blood Pressure (BP) Thresholds and Recommendations for Treatment and Follow-Up 14. BP Thresholds for and Goals of Pharmacologic Therapy in Patients with Hypertension According to Clinical Conditions 15. Oral Antihypertensive Drugs (1 of 3) 16. Oral Antihypertensive Drugs (2 of 3) 17.

5 Oral Antihypertensive Drugs (3 of 3) 18. Heart Failure with Reduced Ejection Fraction (HFrEF) 19. Heart Failure with Preserved Ejection Fraction (HFpEF) 19. DIabetes Mellitus 19. Management of Hypertension in Specific Patient Populations Stable Ischemic Heart Disease (SIHD) 20. Chronic Kidney Disease .. 21. 2018, American College of Cardiology B18060. Acute Intercerebral Hemorrhage 22. Acute ischemic Stroke 23. Previous History of Stroke (Secondary Stroke Prevention) 24. Resistant Hypertension: Diagnosis, Evaluation , and Treatment 25. Diagnosis and Management of a Hypertensive Crisis 26. Intravenous Antihypertensive Drugs for Treatment of Hypertensive Emergencies (1 of 2) 27. Intravenous Antihypertensive Drugs for Treatment of Hypertensive Emergencies (2 of 2) 28. Back to Table of Contents GUIDELINES MADE SIMPLE. BP. 2017 Guideline for the Prevention, Detection, Evaluation , and Management of High Blood Pressure in Adults Categories of BP in Adults*.

6 BP Category SBP DBP. Normal <120 mm Hg and <80 mm Hg Elevated 120 129 mm Hg and <80 mm Hg Hypertension Stage 1 130 139 mm Hg or 80 89 mm Hg Stage 2 140 mm Hg or 90 mm Hg *Individuals with SBP and DBP in 2 categories should be designated to the higher BP category. Table 6. Corresponding Values of Systolic BP/Diastolic BP for Clinic, Home (HBPM), Daytime, Nighttime, and 24-Hour Ambulatory (ABPM) Measurements. Clinic HBPM Daytime ABPM Nighttime ABPM 24-Hour ABPM. 120/80 120/80 120/80 100/65 115/75. 130/80 130/80 130/80 110/65 125/75. 140/90 135/85 135/85 120/70 130/80. 160/100 145/90 145/90 140/85 145/90. 2018, American College of Cardiology B18060. Table 11. 4. Back to Table of Contents GUIDELINES MADE SIMPLE. BP. 2017 Guideline for the Prevention, Detection, Evaluation , and Management of High Blood Pressure in Adults Detection of White Coat Hypertension or Masked Hypertension in Patients Not on Drug Therapy Office BP: Office BP: 130/80 mm Hg but <160/100 mm Hg 120 129/<80 mm Hg after 3 mo trial of lifestyle modification and suspect after 3 mo trial of lifestyle modification and suspect white coat hypertension masked hypertension Daytime ABPM Daytime ABPM.

7 Or HBPM or HBPM. BP <130/80 mm Hg BP 130/80 mm Hg Yes No Yes No Hypertension Masked Hypertension White Coat Hypertension Continue lifestyle Continue lifestyle Elevated BP. Lifestyle modification modification and modification and Lifestyle modification Annual ABPM or HBPM start antihypertensive start antihypertensive Annual ABPM or HBPM to to detect progression drug therapy drug therapy detect MH or progression (Class IIa) (Class IIa) (Class IIa) (Class IIa). Figure 1. 2018, American College of Cardiology B18060. 5. Back to Table of Contents GUIDELINES MADE SIMPLE. BP. 2017 Guideline for the Prevention, Detection, Evaluation , and Management of High Blood Pressure in Adults Detection of White Coat Hypertension or Masked Hypertension in Patients on Drug Therapy Detection of White Coat Effect or Masked Uncontrolled Hypertension in Patients on Drug Therapy Office BP.

8 At goal Yes No Office BP. Increased CVD risk 5 10 mm Hg or target organ damage above goal on 3 agents Yes No Yes No Screen for Screening Screen for Screening masked uncontrolled not necessary white coat effect not necessary hypertension with HBPM (No Benefit) with HBPM (No Benefit). (Class IIb) (Class IIb). HBPM BP HBPM BP. above goal at goal Yes No ABPM BP White Coat Effect: above goal Confirm with ABPM Continue titrating therapy (Class IIa). 2018, American College of Cardiology B18060. Yes No Masked Uncontrolled Hypertension: Continue Intensify therapy current therapy (Class IIb). Figure 2. 6. Back to Table of Contents GUIDELINES MADE SIMPLE. BP. 2017 Guideline for the Prevention, Detection, Evaluation , and Management of High Blood Pressure in Adults Screening for Secondary Hypertension New Onset or Uncontrolled Hypertension in Adults Conditions Drug-resistant/induced hypertension Abrupt onset of hypertension Onset of hypertension at <30 y Exacerbation of previously controlled hypertension Disproportionate TOD for degree of hypertension Accelerated/malignant hypertension Onset of diastolic hypertension in older adults ( 65 y).

9 Unprovoked or excessive hypokalemia Yes No Screen for secondary hypertension Screening not indicated (Class I) (No benefit). (see Table 13). Positive screening test Yes No 2018, American College of Cardiology B18060. Refer to clinician Referral with specific not necessary expertise (No benefit). (Class IIb). Figure 3. 7. Back to Table of Contents GUIDELINES MADE SIMPLE. BP. 2017 Guideline for the Prevention, Detection, Evaluation , and Management of High Blood Pressure in Adults Causes of Secondary Hypertension with Clinical Indications and Diagnostic Screening Tests (1 of 3). Additional/. Clinical Physical Screening Prevalence Confirmatory Indications Exam Tests Tests Common Causes Renal 1% 2% Urinary tract infections; Abdominal mass Renal ultrasound Tests to evaluate parenchymal obstruction, hematuria; (polycystic kidney cause of renal disease urinary frequency and nocturia; disease); skin pallor disease analgesic abuse; family history of polycystic kidney disease.

10 Elevated serum creatinine;. abnormal urinalysis Renovascular 5%-34%* Resistant hypertension; Abdominal systolic- Renal Duplex Bilateral selective disease hypertension of abrupt onset diastolic bruit; bruits Doppler ultrasound; renal intraarterial or worsening or increasingly over other arteries MRA; abdominal CT angiography difficult to control; flash (carotid . pulmonary edemam atherosclerotic or (atherosclerotic); early onset fibromuscular hypertension, especially in dysplasia), femoral women (fibromuscular hyperplasia). Primary 8% 20% Resistant hypertension; Arrhythmias (with Plasma aldosterone/ Oral sodium loading aldosteronism hypertension with hypokalemia hypokalemia); renin ratio under test (prior to 24 h (spontaneous or diuretic- especially atrial standardized urine aldosterone). induced); hypertension and fibrillation conditions or IV saline infusion muscle cramps or weakness; (correction of test with plasma hypertension and incidentally hypokalemia and aldosterone at 4 h discovered adrenal mass; withdrawal of of infusion.)