Just in time for Valentines Day and American Heart Health Month, we have a couple of slides pertaining to Hypertension guidelines that were updated in 2017. This also showcases the need for revised clinical content, as well as some lists for great links on heart health.

1. The 2017 Hypertension
Guideline Update and
the Need for Revised
Clinical Content
P A T S T R I C K E R , R N , M E D
www.tcshealthcare.com/clinical-corner

2. INTRODUCTION
Being a nurse, educator, and content developer for
years, the news of the 2017 update to the (BP)
Blood Pressure Guidelines made me immediately
think about the number of revisions that will need
to be made to written documents, audio/video
media, and computerized programs that contain
hypertension (HTN) information. Examples of
these include patient education materials,
standard patient letters that reflect HTN
information, training materials, reports and
reporting parameters, predictive analytic
programs, related clinical guidelines, clinical
content, care plans, treatment protocols, triage
guidelines, algorithms, websites, BP and
hypertension apps, etc. I know this type of change
seems routine to most people, but when you are
responsible for making these revisions it can be a
large, time-consuming task. If you are not
responsible, you still may want to get more
information about the changes, so you can feel
confident when explaining them to patients. So I
thought I would focus this article on finding
additional information that you can use to
increase your own knowledge and to revise your
HTN materials. However, let’s take a look at the
changes that were made first. .

3. ACC, AHA, JNC7
On November 13, the American College of Cardiology (ACC) and the American Heart Association
(AHA) announced the release of the “2017 Guideline for the Prevention, Detection, Evaluation, and
Management of High Blood Pressure in Adults”. It was developed by the Task Force on Clinical
Practice Guidelines that consisted of representatives from the ACC and AHA, along and nine other
professional organizations[i]. This is the first time the hypertension guideline has been updated
since “The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation,
and Treatment of High Blood Pressure” (JNC7) was released in 2003, 14 years ago.

4. HYPERTENSION
The ACC/AHA Task Force consisted of 21 scientists and health professionals who reviewed over
900 studies and articles related to blood pressure monitoring, risks, treatment goals and
strategies, thresholds to initiate anti-hypertension treatment and control, and various other
topics. They found that the risks of heart disease, stroke, aneurysms, kidney disease, and vision
disorders increase with systolic BPs over 120 mm Hg and that BPs of 130/80 mm Hg can double
the risk. That was significant!
It did not mean that the risk factors had changed or increased; it meant that it is now apparent
that blood pressures at a lower threshold can increase risks more than originally thought. This
is a good thing. It means we can identify and treat individuals sooner, before serious
complications occur as a result of the “Silent Killer” – Hypertension. It also means that the “pre-
hypertension” classification of 120-139/80-89 mm Hg now needs to be changed to “elevated BP”
and “hypertension” and treated as such. The majority of these individuals will be able to be
treated with lifestyle changes (proper diet, exercise, weight loss, reduced smoking and sodium
intake, and stress reduction) to reduce their BP to normal limits, thereby eliminating the need
for medications and reducing their risks of more serious medical complications.

5. The following graph shows a comparison of the 2003 and 2017 BP classifications. The 2017
guideline:
Eliminates the “Pre-hypertension” category and replaces it with:
“Elevated BP” which is 120-129 and <80 mm Hg, and
“Hypertension Stage 1” that is now identified as 130-139 or 80-89 mm Hg
Lowers the BP in “Hypertension Stage 2” category to >140 or >90 mm Hg.
There is also a “Hypertensive Crisis” category for patients with BP >180 and/or 120 mm Hg.

6. Once the guideline and treatment criteria were determined, the Task
Force needed to determine what significance these BP changes would
make to the prevalence of HTN in the U.S. They analyzed data from a
2011-2014 survey of over 9,000 records of adults who had their BP
measured three times following a standard protocol. The average BP was
weighted and compared with BP data obtained using the 2003 JNC7
guidelines in order to make predictions about how the 2017 changes
would impact the U.S. population. Using the 2017 guidelines:
31 million more people will be diagnosed with HTN, increasing the overall
prevalence of HTN in the U.S. to 103.3 million people.
The prevalence of HTN among U.S. adults (> age 20) will increase from
31.9% to 45.6%, an increase of 13.7%.
The number of adults (> age 45) with HTN will triple for men and double
for women.
9.4% of U.S. adults may be treated with non-pharmacological
interventions (lifestyle changes) instead of medications.
The use of anti-hypertensive medications will increase from 34.3% to
36.2%.
81.9 million adults will be treated with medications.
While these statistics look overwhelming, they actually will provide more
individuals with the ability to identify their risk much sooner, thereby
allowing them to make lifestyle changes to reduce their risks and
hopefully eliminate the need to take medications or progress to more
serious medical complications as a result of HTN.

7. ONE OF THE ACC DOCUMENTS OUTLINES 21 POINTS TO
REMEMBER ABOUT THE GUIDELINE AND THE LAST ONE
SEEMS TO SUM UP THE INTENT OF THE GUIDELINE AND
GOALS FOR USING IT.
“Every adult with hypertension should have a clear, detailed, and current evidence-based plan of
care that ensures the achievement of treatment and self-management goals; effective
management of comorbid conditions; timely follow-up with the healthcare team; and adheres to
CVD evidence-based guidelines. Effective behavioral and motivational strategies are recommended
to promote lifestyle modification. A structured team-based approach including a physician, nurse,
and pharmacist collaborative model is recommended, along with integrating home-based
monitoring and telehealth interventions. Outcomes may be improved with quality improvement
strategies at the health system, provider, and patient level. Financial incentives paid to providers
can be useful.”

8. WEBSITE NAVIGATION
Now that you are aware of what the changes are, let’s take a look at what the ACC and AHA
have made available for everyone on their websites. Remember all those items I said that
organizations were going to have to revise? Well, the ACC and AHA have already updated their
websites to reflect the 2017 guideline changes. So you can use their information to increase
your knowledge and make revisions to your content. There is a wealth of knowledge on each
site, so I have listed some of the material that seems to provide the most useful information.
There is also a lot of additional detailed treatment information for each BP classification that
is not listed below. Each website has similar documents, so I have made notes (in bold italics)
next to the documents that seemed to be more concise or easier to use.

9. American Heart Association
New Hypertension Guideline Updates How We Measure and Treat High Blood Pressure – News Release
2017 Hypertension Clinical Guidelines – Overview and Links to numerous documents
Systematic Review – Description of research
National Health and Nutrition Examination Survey (NHANES Survey) – Overview of Survey used for research
data
NHANES Data Source – Data source for 4 year research study to determine changes needed to guidelines
and for comparative data to make predictions of how changes would impact the U.S. population; Good
document for those wanting to review the data
Highlights of 2017 Guideline – 2 page summary of the 2017 Guideline
Hypertension Highlights 2017 - Good detailed summary of Guideline with charts and graphs
Top Ten Things to Know about the 2017 Hypertension Clinical Guideline – Good summary of key points.
Slide Presentation – PDF version of the slides; Actual PPT slides available on ACC website
Nearly half of U.S. adults could now be classified with high blood pressure, under new definitions - News
article
Don’t just get your BP taken; make sure it’s taken the right way - News article
More than half of all African-Americans have high blood pressure under new diagnostic guidelines - News
article
High blood pressure redefined for first time in 14 years: 130 is the new high – News article
Prevalence of US Adults with Hypertension – Graph
Prevalence of US Adults Recommended for Pharmacological Treatment – Graph
Tools & Downloads - For Diagnosis, Treatment Plans, Monitoring, Patient-Measured BP, and Best Practices
AHA Guideline Apps – The website does not show the new HTN Guideline in the picture, but once you load
the app it will ask if you want to update new content. It then adds the HTN guideline content.
IOS for Apple on iTunes
Android on Google
ACC/AHA ASCVD Risk Calculator
ASCVD Risk Calculator

10. American College of Cardiology
New ACC/AHA High Blood Pressure Guidelines Lower Definition of Hypertension – News release
2017 Guideline For the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults
– Comparison graph of 2003 and 2017 guidelines and links to the full Guideline
2017 Guideline – full 193 page Guideline
2017 Guideline for High Blood Pressure in Adults: 21 Key Points to Remember
2017 Guideline_Made_Simple – Good collection of tables and graphs
Guideline Hub | High Blood Pressure – Resource page with links to Quick Reference documents:
Systematic Review – Description of research
Data Supplement – Summaries of research articles used
2017 Guideline for High Blood Pressure in Adults – Key Points to Remember
Guideline Analysis: Potential U.S. Population Impact of the 2017 High Blood Pressure Guideline – Summary
of how predictions were determined
2017 Guideline Slides – Actual PowerPoint Slides
Patient Education
New Guidelines for High Blood Pressure – Good selection of CardioSmart Patient Education and Fact Sheets
High Blood Pressure – Sample of Patient Education Sheet – BP overview, Lifestyle changes and Medications
Guideline Clinical Apps - For Apple IOS on iTunes; the Android version does not appear to have the HTN
guideline

11. I HOPE THESE WILL
HELP YOU BE ABLE
TO NAVIGATE THE
WEBSITES A LITTLE
EASIER AND FIND
THE KEY
INFORMATION YOU
NEED MORE QUICKLY
AND EASILY.
www.tcshealthcare.com/clinical-corner
FOR MORE INFORMATION