New clinical guidelines on hypertension from the USA include a new definition for hypertension, as well as lower treatment targets and extended guidance on the implementation of multidisciplinary care, including self-monitoring of blood pressure. The reclassifying of hypertension will increase the proportion of the US adult population labelled as having hypertension from 32% to 46%, according to estimates by the writing committee which drafted the new guidelines. A systolic blood pressure >120 mmHg is now labelled as elevated blood pressure, a systolic blood pressure of 130–139 mmHg or diastolic blood pressure of 80–89 mmHg is labelled as stage 1 hypertension, and a systolic blood pressure of ≥140 mmHg or a diastolic blood pressure of ≥90 mmHg is labelled as stage 2 hypertension.
This new classification is controversial and places the USA at odds with other countries, point out Professor Richard McManus (University of Oxford) and Professor Jonathan Mant (Primary Care Unit, University of Cambridge) in a commentary published in Nature Reviews Cardiology. Individuals will be labelled with a ‘condition’ they did not previously have. Such labelling is not without its own problems. Whilst the new inclusion of cardiovascular risk in treatment decisions is to be welcomed, consideration must be given to the level of risk that members of the public are willing to accept before initiating treatment, which might be substantially higher than that of the medical profession.
Read the full commentary in Nature Reviews Cardiology, published online 11 January 2018
Image: Dr Jon Ferdinand, Primary Care Unit