Hypertension: Practice changers resulting from the new guidelines
REPORTING FROM THE ANNUAL CARDIOLOGY, ALLERGY, AND RESPIRATORY DISEASE SUMMIT
When to start meds
Another practice changer, according to Davis, is when to start medications based on the new guidelines. “We are now looking at 10-year atherosclerotic risk, and that hasn’t been part of the management guidelines in the past for hypertension.” Similarly, “Treatment goals now have lower targets,” she said.
She explained that for patients who require secondary prevention of recurrent CVD (or if they have clinical CVD), then 10-year risk is irrelevant, and practitioners should start medication when systolic blood pressure (SBP) is ≥130 mm Hg or diastolic blood pressure (DBP) is ≥80 mm Hg. If the patient requires primary prevention (ie, no history of CVD or additional markers of increased risk of CVD) and their atherosclerotic 10-year risk is ≥10%, then medication is also warranted when SPB is ≥130 mm Hg or DBP is ≥80 mm Hg. Davis explained, “Some people might say [10% is] not much of a risk, but that’s considered as high a risk as someone who’s had a heart attack or stroke.”
If a patient requires primary prevention (ie, no history of CVD) and they have a 10-year atherosclerotic risk <10%, then health care providers should start medication when the patient’s SBP is ≥140 mm Hg or DBP is ≥90 mm Hg. Yet, Davis added, as with any patient with any elevation of BP, these patients should adopt lifestyle changes to reduce their BP.
In the end, Davis reminded that these are simply evidence-based guidelines, and that practitioners still need to have discussions with patients about when to start pharmacotherapy.
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