ACC/AHA Hypertension Guideline Update: Recommendations for Managing Blood Pressure

Hypertension is the most prevalent modifiable risk factor for cardiovascular disease and the leading cause of death globally. The last few decades have seen a significant increase in this burden. Roughly 46.7% of US adults exhibited hypertension from 2017-2020. As individuals age, systolic blood pressure levels tend to rise steadily to the end of life. Middle-aged individuals exhibit remaining lifetime risks of incident hypertension of up to 80-90%. Once blood pressure is above normal, patients can experience irreversible vascular damage, even if antihypertensive treatment is started.

Despite the dire nature of this disease, the percentage of individuals aware of the risk and continuously monitoring their blood pressure is low. To that end, the American Heart Association (AHA) and American College of Cardiology (ACC) have released a joint statement detailing new guidelines for the detection, diagnosis, and treatment of hypertension among adult patients. These guidelines update and replace the existing 2017 document, highlighting the forward momentum in therapy development that has appeared over the last few years.

New therapies, such as GLP-1 receptor agonists and aprocitentan, are also highlighted in the document; however, clinicians have suggested caution in readily applying these recommendations. Aprocitentan, a drug studied for a resistant hypertensive population, was later approved by the US Food and Drug Administration (FDA) for the significantly broader indication of uncontrolled hypertension. While this has allowed for more liberal use of the medication, some clinicians believe more testing is necessary before it can be readily adopted. The same goes for GLP-1 RAs, which are still a heavily debated topic in cardiology.

The execution of these updated guidelines is, of course, incumbent on clinicians adopting the new recommendations. Clinicians must emphasize consistent and regular hypertension monitoring, encouraging patients to stay aware of their numbers. After all, one of the most easily applied messages in the ACC/AHA document is to push patients to take an active role in maintaining their blood pressure.