AHA issues new advice on the management of Phase 1 hypertension

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Physicians should consider the use of untreated stage 1 adult medications hypertension (130-139 / 80-89 mm Hg) with a risk of 10 years for atherosclerotic cardiovascular disease is <10% and does not meet the blood pressure target below 130/80 mm Hg after 6 months of pattern-based life therapy, according to the American Heart Association (AHA) in a new scientific statement.

The statement was published online April 29 a Hypertension.

The recommendation complements the 2017 American College of Cardiology / American Heart Association Blood pressure management guidelines, which do not fully address how to control untreated stage 1 hypertension, according to the AHA.

“There are no treatment recommendations in the current guidelines for patients who have a relatively low risk of short-term heart disease when blood pressure does not fall below 130 mm Hg after six months of recommended lifestyle changes .This statement fills that gap, “Daniel W Jones, MD, chairman of the statement writing group and former AHA chairman, said in a press release.

If after 6 months with lifestyle changes, blood pressure does not improve, lifestyle therapy should be continued and “doctors should consider adding medications to control blood pressure,” he said. dir Jones, professor and dean emeritus of the University of Mississippi School of Medicine, Jackson, Mississippi. .

Changes in healthy lifestyle to lower blood pressure include achieving ideal body weight, exercising (30 minutes of moderate to vigorous physical activity most days, if possible), limiting dietary sodium, increasing potassium intake and follow dietary approaches to stop hypertension (DASH) diet, which is abundant in fruits and vegetables with low-fat dairy products and a reduction in saturated fats and total fats. In addition, patients should be advised to limit alcohol intake and not to smoke.

The drafting group recognizes that these goals can be difficult to achieve and maintain over time.

“In the United States and most industrialized countries it is very difficult to limit sodium enough to lower blood pressure and it is difficult for all of us to maintain a healthy weight in what I call a toxic food environment,” Jones said.

“We want doctors to advise patients to take their healthy lifestyle changes seriously and do their best. We certainly prefer to achieve our blood pressure goals without adding medication; however, to successfully treat the blood pressure extends years and quality of life, ”Jones said.

The AHA statement also addresses cases where adults were found to have hypertension during adolescence or childhood and were prescribed antihypertensive drug therapy.

In this patient population, physicians should consider the original indications for initiating antihypertensive drug treatment and the need to continue medication and life therapy as young adults, the AHA advises.

“In young adults with phase 1 hypertension who are not controlled with life therapy, special consideration should be given to the use of antihypertensive drugs in people with a family history of premature BCV, a history of hypertension during pregnancy or personal history of premature birth“says the AHA.

The scientific statement was prepared by the volunteer writing group on behalf of the AHA Council on Hypertension; the Council on Kidney in Cardiovascular Diseases; the Council on Arteriosclerosis, Thrombosis and Vascular Biology; the Radiology and Cardiovascular Intervention Council; the Council of a lifetime Congenital heart disease and Heart health in young people; and the Stroke Tip.

The authors have not disclosed any relevant financial relationship.

Hypertension. Published online April 29, 2021. Full text

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