Impact of the New American Hypertension Guidelines on the Prevalence of Postpartum Hypertension

2018 ◽  
Vol 36 (04) ◽  
pp. 440-442 ◽  
Author(s):  
Jessica Pudwell ◽  
George Saade ◽  
Graeme Smith
Keyword(s):  
Blood Pressure ◽  
Lifestyle Modification ◽  
Secondary Analysis ◽  
Heart Association ◽  
Health Clinic ◽  
Hypertension Guidelines ◽  
Pressure Threshold ◽  
Blood Pressure Threshold ◽  
The Impact ◽  
Diagnosis Of Hypertension

AbstractCardiovascular disease (CVD) is the leading cause of death and disability among women, with more than half occurring in individuals with hypertension. New blood pressure criteria for the diagnosis of hypertension from the American College of Cardiology/American Heart Association recognize that there is no specific blood pressure threshold that is associated with vascular disease. We performed a secondary analysis of two published postpartum databases (the Pre-Eclampsia New Emerging Team [PE-NET] cohort and the Maternal Health Clinic [MHC] cohort) to determine the impact of the change in blood pressure criteria on the diagnosis of hypertension. The prevalence of hypertension in women with uncomplicated pregnancies (PE-NET control) was 22% compared with 56.4% in those who have had a pregnancy complicated by preeclampsia (PE, PE-NET patient) and 67.2% in those referred to the MHC due to a pregnancy complicated by any of the hypertensive disorders of pregnancy. It is well established that certain complications in pregnancy can reliably identify women with risk factors for future CVD. Thus, pregnancy and the postpartum afford a new opportunity for cardiovascular risk screening that could lead to lifestyle modification and therapeutic intervention. Applying the new guideline criteria at least doubles the prevalence of women with hypertension postpartum.

scholarly journals Thoracic Aortic Calcification and Pre-Clinical Hypertension by New 2017 ACC/AHA Hypertension Guidelines

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1027
Author(s):  
Ya-Ting Jan ◽  
Pei-Shan Tsai ◽  
Chris T. Longenecker ◽  
Dao-Chen Lin ◽  
Chun-Ho Yun ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Surrogate Marker ◽  
Heart Association ◽  
Aortic Calcification ◽  
Elevated Blood Pressure ◽  
Elevated Blood ◽  
Contributing Factors ◽  
Hypertension Guidelines ◽  
Pressure Threshold ◽  
Thoracic Aortic Calcification

The recently revised 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension (HTN) guidelines employ a lower blood pressure threshold to define HTN, aiming for earlier prevention of HTN-related cardiovascular diseases (CVD). Thoracic aortic calcification (TAC), a new surrogate marker of aging and aortic medial layer degeneration, and different stages of HTN, according to the 2017 ACC/AHA HTN guidelines, remain unknown. We classified 3022 consecutive asymptomatic individuals enrolled into four HTN categories using the revised 2017 ACC/AHA guidelines: normal blood pressure (NBP), elevated blood pressure (EBP), and stage 1 (S1) and stage 2 (S2) HTN. The coronary artery calcification score and TAC metrics (total Agaston TAC score, total plaque volume (mm3), and mean density (Hounsfield units, HU)) were measured using multi-detector computed tomography. Compared to NBP, a graded and significant increase in the TAC metrics was observed starting from EBP and S1 and S2 HTN, using the new 2017 ACC/AHA guidelines (NBP as reference; all trends: p < 0.001). These differences remained consistent after being fully adjusted. Older age (>50 years), S1 and S2 HTN, prevalent diabetes, and chronic kidney disease (<60 mL/min/1.73 m2) are all independently contributing factors to higher TAC risk using multivariate stepwise logistic regressions (all p ≤ 0.001). The optimal cutoff values of systolic blood pressure, diastolic blood pressure, and pulse pressure were 121, 74, and 45 mmHg, respectively, for the presence of TAC after excluding subjects with known CVD and ongoing HTN medication treatment. Our data showed that the presence of TAC starts at a stage of elevated blood pressure not categorized as HTN from the updated 2017 ACC/AHA hypertension guidelines.

scholarly journals Effect of the physical activity program on the treatment of resistant hypertension in primary care

2018 ◽  
Vol 19 (6) ◽  
pp. 575-583 ◽  
Author(s):  
Piotr J. Kruk ◽  
Michał Nowicki
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Primary Care ◽  
Resistant Hypertension ◽  
Lifestyle Modification ◽  
Heart Association ◽  
Pressure Control ◽  
Physical Activity Program ◽  
Activity Program ◽  
The Impact

AbstractBackgroundRegular physical activity is widely recommended for patients with arterial hypertension as an essential component of lifestyle modification. Much less is known about the impact of physical exercise on the management of treatment of resistant hypertension (RH). The aim was to assess the effect of physical activity program intensified by mobile phone text reminders on blood pressure control in subjects with RH managed in the primary care.MethodsIn total, 53 patients with primary hypertension were qualified, including 27 who met the criteria for RH and 26 with well-controlled hypertension (WCH). Ambulatory 24-h blood pressure was monitored and body composition evaluated with bioimpedance and habitual physical activity profile was determined continuously over 72 h with accelerometer. All measurements were performed at baseline and after three and six months. The patients were asked to modify their lifestyle according to American Heart Association Guidelines that included regular aerobic physical activity tailored to individual needs.FindingsPhysical activity in RH increased significantly after six months compared with control subjects (P=0.001). Office systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the RH group decreased significantly after three months but after six months only office DBP remained significantly lower. After three months 24-h SBP decreased by 3.1±11 mmHg (P=0.08) and DBP by 2.0±6 mmHg (P=0.17) in RH, whereas in WCH respective changes were +1.2±10 and −0.3±6 mmHg. After six months 24-h BP changes were similar.ConclusionIndividualized structured physical activity program increases physical activity in the treatment of resistant hypertensives in primary care but the effect on 24-h blood pressure is only transient.

scholarly journals Extracellular vesicles as a novel diagnostic and research tool for patients with HTN and kidney disease

2019 ◽  
Vol 317 (3) ◽  
pp. F641-F647 ◽  
Author(s):  
Uta Erdbrügger ◽  
Thu H. Le
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Kidney Disease ◽  
Extracellular Vesicles ◽  
Organ Damage ◽  
The United States ◽  
End Organ Damage ◽  
Pressure Threshold ◽  
Stage Renal Disease ◽  
Blood Pressure Threshold

Hypertension (HTN) affects one in three adults in the United States and is a major risk factor for cardiovascular disease and kidney failure. There is emerging evidence that more intense blood pressure lowering reduces mortality in patients with kidney disease who are at risk of cardiovascular disease and progression to end-stage renal disease. However, the ideal blood pressure threshold for patients with kidney disease remains a question of debate. Novel tools to more precisely diagnose HTN, tailor treatment, and predict the risk of end-organ damage such as kidney disease are needed. Analysis of circulating and urinary extracellular vesicles (EVs) and their cargo (protein and RNA) has the potential to identify novel noninvasive biomarkers that can also reflect a specific pathological mechanism of different HTN phenotypes. We will discuss the use of extracellular vesicles as markers of HTN severity and explain their profile change with antihypertensive medicine and potential to detect early end-organ damage. However, more studies with enhanced rigor in this field are needed to define the blood pressure threshold to prevent or delay kidney disease progression and decrease cardiovascular risk.

Society of Behavioral Medicine position statement: Support the updated hypertension guidelines and modify Medicare Part B to improve hypertension management

2019 ◽  
Vol 10 (2) ◽  
pp. 495-497
Author(s):  
Augustine W Kang ◽  
Kenneth E Freedland ◽  
Amy Janke ◽  
Jennifer A Sumner ◽  
Laura L Hayman ◽  
...  
Keyword(s):  
Blood Pressure ◽  
American Heart ◽  
Blood Pressure Monitoring ◽  
Heart Association ◽  
Nutrition Therapy ◽  
Position Statement ◽  
Hypertension Management ◽  
Evidence Based ◽  
Lifestyle Counseling ◽  
Pressure Threshold

Abstract Hypertension contributes to significant global health and economic burdens. The American College of Cardiology/American Heart Association’s latest guideline lowers the blood pressure threshold for hypertension, and as a result, the number of adults with hypertension has increased. Hypertension is a major risk factor for cardiovascular morbidity, especially among older adults. Many individuals who are diagnosed with hypertension at the new, lower threshold may benefit from lifestyle counseling, but changes to existing Medicare policies are required to increase utilization of evidence-based lifestyle counseling approaches to hypertension management. We recommend appropriate funding for the reimbursement of evidence-based lifestyle counseling for hypertension management, the expansion of medical nutrition therapy counseling coverage as an option for Medicare beneficiaries with hypertension, the inclusion of home-based blood pressure monitoring devices in the list of Durable Medical Equipment Coverage, and modifications to the Medicare Benefit Policy Manual to prioritize evidence-based programs such as Dietary Approaches to Stop Hypertension, American Heart Association, and plant-predominant dietary programs.

Impact of diastolic blood pressure threshold for the young population

2019 ◽  
Vol 37 (3) ◽  
pp. 652-653
Author(s):  
Kei Asayama ◽  
Yuki Kinoshita ◽  
Shinya Watanabe ◽  
Takayoshi Ohkubo ◽  
Takashi Ando ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Young Population ◽  
Pressure Threshold ◽  
Blood Pressure Threshold

scholarly journals American Versus European Hypertension Guidelines: The Case of White Coat Hypertension

2020 ◽  
Vol 33 (7) ◽  
pp. 629-633 ◽  
Author(s):  
Cesare Cuspidi ◽  
Federico Paoletti ◽  
Marijana Tadic ◽  
Carla Sala ◽  
Raffaella Dell’Oro ◽  
...  
Keyword(s):  
European Society ◽  
American Heart ◽  
Prognostic Significance ◽  
Heart Association ◽  
White Coat ◽  
Uncontrolled Hypertension ◽  
White Coat Hypertension ◽  
Hypertension Guidelines ◽  
Esc Guidelines ◽  
The Impact

Abstract BACKGROUND The impact of the 2017 American College Cardiology/American Heart Association guidelines on reclassification of white coat hypertension (WCH) and white coat uncontrolled hypertension (WUCH) phenotypes has not been thoroughly investigated, so far. The aim of the present analysis was to compare the prevalence rates of WCH and WUCH according to either 2018 European Society Hypertension/European Society Cardiology and 2017 ACC/AHA hypertension guidelines. METHODS A large database of individual 24-hour ambulatory blood pressure (BP) recordings from untreated and treated hypertensive individuals with office BP ≥140 and/or 90 mm Hg was analyzed. RESULTS As many as 3,223 (39% men) out of 7,353 (47% men) fulfilled diagnostic criteria for WCH (n = 1,281) and WUCH (n = 1,942) according to the 2018 ESH/ESC guidelines (mean 24-hour BP &lt;130/80 mm Hg), the prevalence rate being 17.4% and 26.4%, respectively. The corresponding figures according to the 2017 ACC/AHA guidelines (mean 24-hour BP &lt;125/75 mm Hg) were 15.6 and 9.4%, respectively. Thus, a total of 1,378 patients (42.7%) either defined as WCH and WUCH by ESH/ESC guidelines, were classifiable as untreated sustained and uncontrolled sustained hypertensives by ACC/AHA guidelines. CONCLUSIONS The ACC/AHA reclassification of patients with office BP ≥140/90 mm Hg leads to a marked decrease in the prevalence of WCH/WUCH. This may have relevant clinical implications because the prognostic significance of these phenotypes is often ignored in clinical practice and, consequently, contributes to the high burden of cardiovascular diseases worldwide.

scholarly journals New АСС/AHA and ESC/ESH arterial hypertension guidelines

2018 ◽  
Vol 17 (5) ◽  
pp. 99-119 ◽  
Author(s):  
E. V. Reznik ◽  
I. G. Nikitin
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
European Society ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
National Guidelines ◽  
Hypertension Guidelines ◽  
European Society Of Cardiology ◽  
Detection Evaluation

The American College of Cardiology and the American Heart Association updated the guideline for the prevention, detection, evaluation and management of high blood pressure in adults in 2017 The European Society of Cardiology and the European Society оf Hypertension updated guidelines for the management of arterial hypertension in 2018. This article reviews new positions of these documents, compares approaches to current issues of managing of the patients with arterial hypertension, pro and contra with previous versions of similar documents. It is necessary to update the National guidelines for management of patients with arterial hypertension, which should include the dignity of both European and American approaches.

scholarly journals 29: DIASTOLIC BLOOD PRESSURE THRESHOLD DURING PEDIATRIC CPR AND OUTCOMES: A MULTICENTER VALIDATION STUDY

2021 ◽  
Vol 50 (1) ◽  
pp. 15-15
Author(s):  
Robert Berg ◽  
Ryan Morgan ◽  
Ron Reeder ◽  
Kellimarie Cooper ◽  
Kathryn Graham ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Validation Study ◽  
Pressure Threshold ◽  
Blood Pressure Threshold ◽  
Multicenter Validation

scholarly journals Characteristics of US adults who would be recommended for lifestyle modification without antihypertensive medication to manage blood pressure

2020 ◽  
Author(s):  
Sandra L Jackson ◽  
Soyoun Park ◽  
Fleetwood Loustalot ◽  
Angela M Thompson-Paul ◽  
Yuling Hong ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Lifestyle Modification ◽  
Sodium Intake ◽  
Heart Association ◽  
Lifestyle Changes ◽  
Elevated Blood Pressure ◽  
Elevated Blood ◽  
Cvd Risk ◽  
Cross Sectional ◽  
Stage 1

Abstract Background The 2017 American College of Cardiology / American Heart Association Guideline for blood pressure (BP) management newly classifies millions of Americans with elevated blood pressure or stage 1 hypertension for recommended lifestyle modification alone (without pharmacotherapy). This study characterized these adults, including their CVD risk factors, barriers to lifestyle modification, and healthcare access. Methods This cross-sectional study examined nationally representative National Health and Nutrition Examination Survey data, 2013-2016, on 10,205 US adults aged ≥18, among whom 2,081 had elevated blood pressure or stage 1 hypertension and met 2017 ACC/AHA BP Guideline criteria for lifestyle modification alone. Results An estimated 22% of US adults (52 million) would be recommended for lifestyle modification alone. Among these, 58% were men, 43% had obesity, 52% had low quality diet, 95% consumed excess sodium, 43% were physically inactive, and 8% consumed excess alcohol. Many reported attempting lifestyle changes (range: 39%-60%). Those who reported receiving health professional advice to lose weight (adjusted prevalence ratio 1.21, 95% confidence interval 1.06-1.38), reduce sodium intake (2.33, 2.00-2.72), or exercise more (1.60, 1.32-1.95) were significantly more likely to report attempting changes. However, potential barriers to lifestyle modification included 28% of adults reporting disability, asthma, or arthritis. Additionally, 20% had no health insurance and 22% had no healthcare visits in the last year. Conclusions One fifth of US adults met 2017 ACC/AHA BP Guideline criteria for lifestyle modification alone, and many reported attempting behavior change. However, barriers exist such as insurance gaps, limited access to care, and physical impairment.

Sign in / Sign up

Export Citation Format

Share Document