This article is more than 5 years old. Information may no longer be current.

New hypertension guidelines lack critical guidance for managing younger patients

The recent 2017 hypertension guidelines issued by the American College of Cardiology and the American Heart Association do not provide clear direction on how to treat and manage younger hypertensive patients who are most affected by the updates, according to a commentary published in Annals of Internal Medicine.

Although the new guidelines are extremely meticulous, they “bombarded the intended audience — clinicians on the frontline of patient care — with a mountain of information that may have spawned as many questions as it answered,” Jordana B. Cohen, MD, MSCE, and Raymond R. Townsend, MD, both from the University of Pennsylvania, wrote.

The 2017 ACC/AHA guidelines lowered the recommended threshold for diagnosing hypertension in the general population from 140/90 mm Hg to 130/80 mm Hg. This new diagnostic threshold will intensify the population-wide burden of hypertension in the United States, according to data from the National Health and Nutrition Examination Survey. Specifically, the prevalence of hypertension will surge for patients aged younger than 45 years, tripling for men and almost doubling for women.

However, Cohen and Townsend noted that existing trials that have evaluated aggressive BP-lowering tactics do not adequately account for the younger group of patients that is most impacted by the new guidelines. Additionally, they argue that the ACC/AHA guidelines do not offer clear guidance on how to manage and treat these low-risk patients if 3 to 6 months of lifestyle modifications do not help them achieve their BP goals.

Although the new guidelines highlight the significance of proper in- and out-of-office BP measurements using the appropriate methodology, Cohen and Townsend claim that it can be extremely difficult to obtain accurate measurements because of decreasing insurance reimbursement and “hectic” workflows at clinics. In addition, they note that oftentimes clinicians measure BP levels after a patient has been waiting in a loud area and moved to the doctor’s office without time to rest. It is often rare that clinicians have the opportunity to measure BP levels in quiet areas, they added.

“The potential benefits of any guidelines must be considered along with their consequences,” Cohen and Townsend concluded. “Guidelines frequently inform changes in policy and insurance reimbursement and can affect the physician–patient relationship.”

“Furthermore, the recent incongruity in guidelines may jeopardize patients' trust in the health care system,” they added. “As providers, the most valuable conclusion we can convey to our patients is that a guideline is never a substitute for clinical judgment.” – by Alaina Tedesco

Disclosure: The authors report no relevant financial disclosures.