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For the first time in 14 years, there has been an update of the "Seventh Report of the National Committee on Preventionnew High Pressure Guidelines have been implemented by the American College of Cardiology (ACC) /American Heart Association (AHA).

FightHighBloodPressure.com has announced a major global campaign to partner with Medical Groups and Healthcare Organizations to improve Hypertension control through the use of home blood pressure monitoring devices. Home blood pressure monitoring when performed in conjunction with a Medical Group or Healthcare provider, is an important way patients can detect and control Hypertension.

#checkyourBPdaily Challenge will provide a wealth of knowledge based on best practices for home blood pressure monitors in an ambulatory care setting. Patient recruitment, enrollment, and engagement; modifications in care processes and therapies; and patient and provider satisfaction.

High blood pressure, also known as hypertension in the scientific term, was coined as the leading cause of death and disability-adjusted life years worldwide in 2010. Since then, the prevalence rate and lifetime risk of high blood pressure have steadily increased. Further extension of researches and studies into this domain suggest the varying lifetime risk of the disease. A study named multi-ethnic study of atherosclerosis (MESA) presents that the percentage of African Americans and Hispanics developing hypertension throughout the life was higher than that for the Asians and white people. A lot of data has been collected on high blood pressure by the medical practitioners and researchers. But, still, there is a dire need to build a bridge between the patient’s lack of understanding and what the disease of high blood pressure actually is. To a lot of hypertensive patients, popping up a pill every morning and evening might have become a routine but the real compliance lies in the true understanding of how this ill health condition works.

Why is it necessary to manage? How deteriorating it can be?

Hypertension and its association with cardiovascular diseases The proportional risk relation between the increased blood pressure and cardiovascular insults depicts the importance of controlling the blood pressure. It is one of the main reasons why you need to comply with the management of this disease. Hypertension can result in left ventricular hypertrophy, left atrial size increase, diastolic dysfunction, changes in the cardiac structure and ultimately, heart failure. The Cardiovascular Health Study and the Health, Aging and Body Composition Study shows that 11.2% of 4408 persons (not receiving antihypertensive drugs at baseline) developed HB over 10 years. While on the other hand, another study showed that lowering of SBP to <130/80 mm Hg reduced CVD complications by 25% and overall mortality rate by 27% in patients with CVD risk.

Studies, Scope, and Implementation of the hypertension guidelines

The work in this field started in the early 1920s and the imminent danger to life due to increasing level of BP was declared in the 1959 Build and Blood Pressure Study. Since then, plan of care for hypertensive patients are devised keeping in view the modifiable and non-modifiable determinants of health and social behavior.

Fight High Blood Pressure.com abides by the latest guidelines recently issued in the year 2017. We aim to deliver the updated care plan for our audience. This updated version of the NHLBI publication, “The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure” (JNC 7) will be posted on our site in days to come.

Moving ahead with this data requires a prior understanding of the basics of hypertension which are as follows: Understanding hypertension!

What is hypertension?

According to the updated Hypertension guidelines by the American Heart Association, the American College of Cardiology and nine other societies; the high blood pressure is defined as systolic and diastolic BP as 130 and 80 mm Hg respectively. It is categorized into normal BP, elevated BP, stage 1 or stage 2 BP based on at least 2 or more careful readings noted on 2 or more occasions.

The components of BP that matter includes systolic and diastolic blood pressure, pulse pressure, or BP, and mid-BP. The epidemiological studies have also evaluated their associations with CVD outcomes. The ambulatory or home BP monitoring is the most common way of keeping it in check.

Causes of hypertension:

If there is one question that every hypertensive patient wants an answer to, it is the universal ‘why me’ question. The answer is unsatisfactory as the reason for primary hypertension leads back to genetic predisposition or environmental factors like obesity, physical fitness, alcohol intake, and sodium consumption. Secondary hypertension, on the other hand, is the result of renal artery stenosis or some metabolic disturbance in the body. Either way, you are required to take care of your being and this is why managing your conditon matters most. The management is effective only of it the clinical implementation guidelines are followed by both the practitioner and the patient. Thus, know your disease and work accordingly! How to evaluate, manage and treat hypertension? Every practitioner starts by carrying out some basic tests. You might, in the heat of the moment, consider your doctor’s approach as unnecessary but the studies carried out worldwide prove their importance in one way or the other. Hence, some of the optimal tests include:

Once the diagnosis is made, next in line come the treatment options:

Non-pharmacological interventions

The patients falling in normal BP and elevated BP (120-129/ <80 mm Hg) are solely managed by the non-pharmacological interventions. These include (in order of priority) weight loss, DASH eating plan, sodium reduction, potassium supplementation, increased physical activity and reduced alcohol intake.

Pharmacological interventions

The management of risk factors required both non-pharmacological and pharmacological interventions especially in those patients with stage 1 or stage 2 HBP, and other co-morbidities like diabetes mellitus and chronic kidney disease.

The ultimate goal is to reduce the blood pressure levels along with underlying CVD risk and for this five classes of antihypertensive drugs (ACEi, ARBs, diuretics, CCBs and B-blockers) are used. The clinical monotherapy and the combined drug therapy are weighed against each other in every case, as each patient differs from one another, and are prescribed accordingly. The need to focus on compliance of medical interventions is highly required as studies show that up to 25% of patients do not fill their initial prescription for antihypertensive therapy.

Hypertension is manageable only if you know what you are dealing with and how you can beat it!

HBP facts

make lifestyle changes asap!! Purchase a HELO for you and your family! Monitor your Bio-parameters 24/7! ​ High Blood Pressure- an Overview

make lifestyle changes asap!! Purchase a HELO for you and your family! Monitor your Bio-parameters 24/7! ​ High Blood Pressure- an Overview High blood pressure is the second largest cause of preventable deaths from heart disease and stroke. Hypertension is also called the silent killer because many patients do not feel any symptoms and are unaware that they might be at high risk of heart disease and stroke.

The American College of Cardiology (ACC) and the American Heart Association (AHA) have collaborated with the National Heart, Lung, and Blood Institute (NHLBI) to complete four guidelines on assessment of cardiovascular risk, lifestyle modifications to reduce this risk, management of blood cholesterol in adults and management of overweight and obesity in adults. In 2014, both the ACC and AHA developed a guideline on the prevention, detection, evaluation, and management of high blood pressure (BP) in adults. The ultimate goal of these guidelines is to help clinicians control and manage BP in patients with or at risk of cardiovascular disease (CVD).

However, these ACC/AHA clinical practice guidelines are continuously reviewed, updated and modified (if required). In other words, these guidelines continue to evolve based on new study results and new drugs, devices and/or management strategies. In 2017, the ACC and the AHA have released a new guideline on hypertension. This new guideline also comes with a new definition of high blood pressure.

New ACC/AHA Hypertension Guidelines

As per the new ACC/AHA hypertension guidelines, BP is categorized into for levels based on the average BP measured in a normal healthcare setting. The new categorization is different from the old one and now follows this formula:

Here is a snapshot of the primary difference between the previous guidelines and the new 2017 guidelines:

Systolic/Diastolic Blood Pressure

Previous Guidelines

2017 Guidelines

<120 and <80


Normal BP

Normal BP


120–129 and <80

Prehypertension

Elevated BP

130–139 or 80–89

Prehypertension

Stage 1 hypertension

140–159 or 90–99

Stage 1 hypertension

Stage 2 hypertension

> 160 or >100

Stage 2 hypertension

Stage 2 hypertension

The category of prehypertension has been eliminated in the new guideline. Patients will now either be categorized as having elevated BP or stage 1 hypertension. The goal is to catch BP problems in younger people since it is estimated that the prevalence of high blood pressure is likely to trip among men under the age of 45 and double among women under the age of 45. In other words, high blood pressure could be a problem as soon as you get into your 40s and that is why close monitoring and accurate measurement and diagnosis is the key to preventing additional complications.

Accurate Blood Pressure Measurement

A major component of these new guidelines is an emphasis on accuracy blood pressure measurement. The guidelines recommend the use of average measurements taken over several visits. An important change to these guidelines is a focus on out-of-office blood pressure measurements. Significant emphasis has been placed on accurate blood pressure management mainly because this measurement is essential to categorize the level of BP as well as to ascertain CVD risk and guide the treatment protocol for BP management. The ACC/AHA guidelines recommend an average of 2 to 3 BP measurements obtained on 2 to 3 separate occasions. In addition, patients and caregivers who perform self-monitoring of BP should be properly trained as per a new checklist. These measures are likely to result in accurate BP measurement.

The importance of home blood pressure monitoring with proper training and validated devices is essential as per the new guidelines. If done properly, this can reveal cases of white-coat hypertension which typically occurs in a medical setting but not in everyday life. Similarly, home blood pressure monitoring can also help identify masked hypertension which refers to a situation where blood pressure appears to be normal in a medical setting but is elevated at home. This may require a non-pharmacological treatment approach initially and close monitoring to ensure pharmacological treatment is initiated as and when required.

New Treatment Approach of Hypertension

The new guidelines incorporate underlying cardiovascular risk and also aim for lower targets for blood pressure during the management of hypertension. In addition, the new guidelines recommend a treatment approach that not only relies on drugs but also emphasizes on a change in lifestyle approaches to facilitate better blood pressure management.

There is no doubt that the new ACC/AHA classification will result in an increase in the prevalence of hypertension. To be specific, the prevalence of hypertension in the US with the new definition increases to 46% compared to 32% as per the previous guideline. However, the new definition only results in a small increase in the percentage of adults who would be put on antihypertensive medication. The new guidelines are more focused on non-pharmacological treatment based on their risk of developing cardiovascular disease.

The guidelines clearly communicate that patients who are already on antihypertensive medication need more intensive lowering of blood pressure. This intensive blood pressure management should be guided by the patient's underlying risk of cardiovascular disease. Those with a 10% or more will require drug treatment while those with a lower risk should be managed through the use of lifestyle modification approaches. These approaches will include a focus on losing weight, following a DASH diet, reducing sodium to less than 1500mg/day and increasing potassium intake to 3500mg/day. Physical activity must be increased to at least 30 minutes three times per week. Alcohol consumption should be limited to two drinks or less in men and one drink or less in women.

Conclusion

The goal of the new guidelines is to ensure that blood pressure issues are identified at an early stage so that people at risk of cardiovascular disease and other complications can be accurately diagnosed and treated in time. Keep in mind that despite an increase in the prevalence of hypertension as per the new guidelines, there will not be as substantial an increase in the use of antihypertensive medication. The goal is to strike a balance between pharmacological and non-pharmacological approaches, using both as per the specific patient symptoms, classification and risk levels.

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Membership is open to all Health systems and medical groups. Your Participation serves as an example of exemplary leadership and commitment to engage, educate & encourage our population to #checkyourBP daily.

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Membership is open to all Health systems and medical groups. Your Participation serves as an example of exemplary leadership and commitment to engage, educate & encourage our population to #checkyourBP daily.

 

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