2020–2021 BCSC Basic and Clinical Science Course™
1 Update on General Medicine
Chapter 3: Hypertension
Highlights
-
The American College of Cardiology (ACC) and the American Heart Association (AHA) guidelines published in November 2017 state that in adults, a normal blood pressure (BP) is less than 120/80 mm Hg. Treatment with lifestyle modifications and medications is now recommended in some individuals with a BP greater than or equal to 130/80 mm Hg.
-
The prehypertension category has been eliminated in the 2017 ACC/AHA guidelines. The BP goals set by many subspecialty associations are more aggressive than those of JNC 7, especially for patients with diabetes mellitus, proteinuria, congestive heart failure, or renal insufficiency.
-
The risk of cardiovascular disease, which begins at a BP of 115/75 mm Hg, doubles with each 20/10 mm Hg increase in BP.
-
Masked hypertension (BP that is normal in the office but elevated when measured at home) carries a worse prognosis than “white coat” hypertension with regard to development of arteriosclerosis.
-
Thiazide-type diuretics are no longer the first-line therapy for hypertension, except in patients with cardiovascular issues. Depending on the history and comorbidities of the patient with hypertension, treatment with a renin-angiotensin system (RAS) blockade, β-blockers, or calcium channel blockers (CCBs) may be initiated.
-
Combination therapy, or 2 or more medications, at onset of hypertension is indicated for patients whose BP is 20/10 mm Hg or more above goal.
-
Hypertension is increasingly common in children and adolescents as well as in women aged 45 years and older and has substantial long-term health implications.
Excerpted from BCSC 2020-2021 series: Section 1 - Update on General Medicine. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.