The document summarizes key points from the 2017 ACC/AHA hypertension clinical practice guidelines. It outlines a new blood pressure classification system with lower targets for managing hypertension. It emphasizes accurate blood pressure measurement, lifestyle modifications like weight loss and reducing sodium intake, and initial treatment with thiazide diuretics, calcium channel blockers, or ACE inhibitors/ARBs. The guidelines recommend developing a specific care plan to achieve and sustain blood pressure control through reducing cardiovascular risk factors and social determinants of health.

1. MUHAMMED SHARKY A
M pharm (pharmacy practice)
JKKN COLLEGE OF PHARMACY
msharky161@gmail.com

2. HYPERTENSION CLINICAL PRACTICE
GUIDELINES 2017

3. HIGHLIGHTS
• A strong emphasis on blood-pressure measurement,
both accuracy of blood-pressure measurements and
using the average of measures taken over several
visits, as well as an emphasis on out-of-office blood-
pressure measurements
• A new blood-pressure classification system
• Lower targets for blood pressure during the
management of hypertension
• Strategies to improve blood-pressure control during
treatment with an emphasis on lifestyle approaches
Individuals

4. A New ACC/AHA-Guidelines Blood-
Pressure Classification System

5. BP Goal for Patients with
Hypertension(Recommendation)
• For adults with confirmed hypertension and
known CVD or 10-year ASCVD event risk of
10% or higher, a BP target of less than
130/80 mm Hg is recommended
• For adults with confirmed hypertension,
without additional markers of increased CVD
risk, a BP target of less than 130/80 mm Hg
may be reasonable

6. Blood Pressure Classification by JNC7
and 2017 ACC/AHA Hypertension
Guidelines
Systolic, Diastolic Blood
Pressure (mm Hg)
JNC7 2017 ACC/AHA
<120 and <80 Normal BP Normal BP
120–129 and <80 Pre hypertension Elevated BP
130–139 or 80–89 Pre hypertension Stage 1 hypertension
140–159 or 90–99 Stage 1 hypertension Stage 2 hypertension
> 160 or >100 Stage 2 hypertension Stage 2 hypertension

9. SBP DBP CVD/Risk/other
circumstances
Recommended treatment
<120 mm Hg & <80 mm Hg N/A Healthy Lifestyle
120-129 mm
Hg
& <80 mm Hg N/A Nonpharmacological
therapy
130-139 mm
Hg
OR
80-89 mm Hg No CVD/10 yr
ASCVD risk <10%
Antihypertensive drug
therapy (Plus non
pharmacological therapy)130-139 mm
Hg
OR
80-89 mm Hg CVD/10 yr ASCVD
risk ≥10%
≥130 mm Hg OR
≥80 mm Hg Diabetes or CKD
≥130 mm Hg Age ≥65 yrs
≥140 mm Hg OR
≥90 mm Hg N/A
*ASCVD, atherosclerotic cardiovascular disease; CKD, chronic kidney disease; CVD, cardiovascular disease; N/A, not
applicable

10. Treatment of High BP
• Lifestyle modification is the cornerstone of the
hypertension treatment
Specific recommendations includes
• Weight loss is recommended
• A heart-healthy diet, such as the DASH (Dietary
Approaches to Stop Hypertension) is recommended
• Sodium reduction is recommended
• Increase physical activity with a structured exercise
program is recommended
• Limit alcohol intake, no more than 2 for a men and 1
for women standard drinks* per day
*1 "standard" drink contains roughly 14 g of pure alcohol, which is typically found in 12 oz of regular beer (usually
about 5% alcohol), 5 oz of wine (usually about 12%
alcohol) and 1.5 oz of distilled spirits (usually about 40% alcohol)

11. Choice of Initial
Medication
For initiation of antihypertensive drug therapy, first-
line agents
include thiazide diuretics, CCBs and ACE inhibitors or
ARBs.
Choice of Initial Monotherapy
Versus Initial Combination Drug
Therapy
>> Initiation of antihypertensive drug therapy with 2
first-line agents of different classes, either as
separate agents or in a fixed-dose combination, is
recommended in adults with stage 2 hypertension
and an average BP more than 20/10 mm Hg above
their BP target.
>> Initiation of antihypertensive drug therapy with a
single antihypertensive drug is reasonable in adults
with stage 1 hypertension and BP goal <130/80 mm
Hg with dosage titration and sequential addition of
other agents to achieve the BP target

12. The Hypertension Care Plan
• A specific plan of care for hypertension is
essential and should reflect understanding of the
modifiable and nonmodifiable determinants of
health behaviors, including the social
determinants of risk and outcomes.
• Implementation of a plan of care for
hypertension can lead to sustained reduction of
BP and attainment of BP targets over several
years.
References: 1: Whelton PK, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection,
Evaluation, and
Management of High Blood Pressure in Adult. A Report of the American College of Cardiology/American Heart Association Task Force on Clinical
Practice Guidelines.
Hypertension. 2017; 2: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood
Pressure. Editors: National
High Blood Pressure Education Program. Source Bethesda (MD): National Heart, Lung, and Blood Institute (US); 2004 Aug. Report No.: 04-5230.

13. Reference
• Hypertension Clinical Practice Guidelines
2017
• Dr. Paul K Whelton Chairperson & Principal
Author 2017 ACC/AHA Guideline Committee.