SOURCE: Goldfarb IT. JAMA 2017;318:2075-2076.

The most recent American Heart Association/American College of Cardiology (AHA/ACC) hypertension guidelines have created a literature stir, although there remain many clinicians who are not wholly on board with the updated recommendations. Since 1977, when the first National Heart, Lung, and Blood Institute-directed guidance on hypertension was issued, periodic updates have occurred. In 2013, responsibility for cardiovascular disease clinical practice guidelines was transferred to the AHA/ACC, which subsequently released this lengthy and detailed 2017 document.

Perhaps the most novel innovation is the recategorization of systolic blood pressure 130-139 mmHg or diastolic blood pressure 80-89 mmHg as stage 1 hypertension. Previously, this blood pressure zone was labeled prehypertension. The rationale for the new designation is, in part, that previous data indicated as much as a two-fold increase in cardiovascular disease risk when stage 1 hypertension is compared to blood pressure < 120/80 mmHg, coupled with convincing results from recent trials (e.g., SPRINT) that indicate systolic blood pressure levels < 120 mmHg are not only achievable — and, for the most part, safe — but also improve cardiovascular outcomes. Not all major agencies are advocates. For instance, the American Academy of Family Physicians (AAFP) has not endorsed the new guidelines, but instead advocates for the JNC 8 document, which the AAFP suggests provides a more robust evidence base.