New blood pressure guideline updates explained

Editor's Note

Surgical care can be influenced if a patient has high blood pressure, including for preoperative assessment, intraoperative monitoring and to prevent postoperative complications such as heart and kidney injury, stroke, and death. An overview of updated blood pressure guidance updates to the 2017 Blood Pressure Guidelines released by the American Heart Association and the American College of Cardiology were described in an October 31 article published in JAMA.

Definitions of normal, elevated, and stage 1 and 2 hypertension were unchanged in the update and the recommended first-line treatment via antihypertensives remains the same. However, several updates can influence surgical care, including preoperative patient health with updated targets for earlier treatment and tighter blood pressure control, as reported in the article. For example, the phrasing for people with hypertension with heightened cardiovascular disease risk is to achieve at least less than 130 mm Hg, with encouragement to achieve less than 120 mm Hg. For those with hypertension who are not at increased risk of cardiovascular disease, the same goal may be reasonable to prevent their blood pressure from climbing higher, the article on guideline updates states.

People with stage 1 hypertension who don’t have clinical cardiovascular disease and who also have a low 10-year risk should use lifestyle changes are advised in the guideline update to bring down their blood pressure, but they should start antihypertensives if they’re not at goal in 3 to 6 months, according to the article. It was noted that the previous guideline recommended that this lower-risk population wait until stage 2 hypertension to initiate drug therapy.

The update also recommends immediate medication initiation for people with stage 1 hypertension who don’t have clinical cardiovascular disease but do have diabetes or chronic kidney disease. One reason for recommending earlier medication intervention is based on evidence to reduce dementia risk. One contributor cited in the article discussed how high blood pressure can damage small blood vessels in regions of the brain responsible for cognitive function. This damage can occur similar to how high blood pressure damages the microvasculature of the brain leading to ischemic stroke.