American Heart Association Advises Considering Medication for Certain Patients With Stage 1 Hypertension

Medication should be considered for patients with slightly elevated blood pressure who do not respond to 6 months of healthy lifestyle changes, according to a new statement from the American Heart Association (AHA) published in Hypertension. This statement serves to fill a gap in guideline recommendations by addressing how to manage untreated, stage 1 high blood pressure not fully addressed in the 2017 treatment guidelines.

The 2017 American College of Cardiology/American Heart Association Blood Pressure Management Guidelines' recommendation for patients with stage 1 hypertension—defined as blood pressure levels of 130-139/80-89 mm Hg—and a low risk of heart attack or stroke within 10 years is to first treat with healthy lifestyle changes, and then repeat the blood pressure check in 6 months. For patients with stage 1 hypertension and a high 10-year risk of heart attack or stroke, the guidelines recommend antihypertensive medication in addition to healthy lifestyle.

The newly issued statement suggests clinicians should consider medication for patients with a low 10-year risk if the blood pressure goals (<130/80 mm Hg) are not met after 6 months of sustained healthy lifestyle changes. This would apply to around 10% of American adults with high blood pressure.

Many patients with stage 1 hypertension are adults under age 40 years. Randomized controlled trials following these patients for cardiovascular disease risk are lacking, leading the statement writing committee to base their conclusion on other forms of evidence, including observational studies focused on the relationship between blood pressure and cardiovascular disease.

“We know that people with blood pressure lower than 130/80 mm Hg have fewer markers of cardiovascular risk like elevated coronary calcium, enlargement of the heart, or buildup of fatty deposits called atherosclerosis in arteries of the neck,” said Daniel W. Jones, MD, FAHA, chair of the statement writing group, in a press release. “There is strong evidence that treating high blood pressure saves lives by reducing the risks for heart attack and stroke.”

The healthy lifestyle changes recommended include achieving ideal body weight, exercising, limiting dietary sodium, enhancing potassium intake and following the Dietary Approaches to Stop Hypertension (DASH) diet. The DASH diet consists of a combination diet with fruits and vegetables, low-fat dairy products, and reduced saturated and total fats. It is recommended that these patients limit alcohol and forego smoking.

“It is very hard in America and most industrialized countries to limit sodium sufficiently to lower blood pressure, and it is difficult for all of us to maintain a healthy weight in what I refer to as a toxic food environment,” Jones said in the release. “We want clinicians to advise patients to take healthy lifestyle changes seriously and do their best. We certainly prefer to achieve blood pressure goals without adding medication; however, successfully treating high blood pressure does extend both years and quality of life.”

REFERENCE

If slightly high blood pressure doesn't respond to lifestyle change, medication can help [news release]. EurekAlert; April 29, 2021. Accessed April 29, 2021. https://www.eurekalert.org/pub_releases/2021-04/aha-ish042621.php