New blood pressure guidelines issued

August 1, 2003

Pharmaceutical Representative

The National Heart, Lung, and Blood Institute has released new clinical practice guidelines for the prevention, detection and treatment of high blood pressure.

The National Heart, Lung, and Blood Institute has released new clinical practice guidelines for the prevention, detection and treatment of high blood pressure. The guidelines, which were approved by the coordinating committee of the NHLBI's National High Blood Pressure Education Program, feature altered blood pressure categories, including a new "prehypertension" level that covers about 22% of American adults or about 45 million persons.

The new guidelines, which appeared in the Journal of the American Medical Association (vol. 289, no. 19), also streamline the steps by which doctors diagnose and treat patients, and recommend the use of diuretics as part of the drug treatment plan for high blood pressure in most patients.

Guideline highlights

Key aspects of the new guidelines include:


•Â A new "prehypertension" level and merging of other categories. The new report changes the former blood pressure definitions to: normal (less than 120/less than 80 mm Hg), prehypertension (120-139/80-89 mm Hg), stage 1 hypertension (140-159/90-99 mm Hg), stage 2 hypertension (at or greater than 160/at or greater than 100 mm Hg).


•Â Recommendations for the use of a diuretic, either alone or in combination with another drug class, as part of the treatment plan in most patients. The guidelines also list other drug classes that have been shown to be effective in reducing hypertension's cardiovascular complications and that may be considered to begin therapy, like ACE inhibitors, angiotensin receptor blockers, beta-blockers and calcium channel blockers. The report also lists the high-risk conditions for which such drugs are recommended as initial therapy.


•Â Recommendations for the use of additional drugs for severe hypertension or to lower blood pressure to the desired level. According to the new report, most persons will need two, and at times three or more, medications to lower blood pressure to the desired level.

Control, awareness and treatment rates

The guidelines include new data on control, awareness and treatment rates for high blood pressure in the United States. According to a national survey, 70% of Americans with hypertension are aware of their high blood pressure, 59% are being treated for it and 34% have it under control. Those percentages represent a slight improvement over rates for 10 years ago, when 68% of Americans with hypertension were aware of their high blood pressure, 54% were being treated for the condition and 27% had it under control. By contrast, about 25 years ago, 51% of Americans with hypertension were aware of their high blood pressure, 31% were being treated and 10% had it under control.

"Though improved, the treatment and control rates are still too low," said Aram V. Chobanian, dean of Boston University School of Medicine and chair of the joint national committee that produced the new guidelines. "The new guidelines zero in on this problem, recommending factors that often lead to inadequate control such as not prescribing sufficient medication. The guidelines stress that most patients will need more than one drug to control their hypertension and that lifestyle measures are a crucial part of treatment." PR

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