Global Impact of 2017 American Heart Association/American College of Cardiology Hypertension Guidelines

The 2017 American Heart Association/American College of Cardiology (AHA/ACC) guidelines for the prevention, detection, evaluation, and management of high blood pressure (BP) in adults were recently released.1 The core concept in these guidelines is earlier and tighter BP control over 24 hours, with the aim of providing more sustained target organ protection and cardiovascular disease prevention. These guidelines lower the threshold of hypertension diagnosis and target BP levels to 130/80 mm Hg. This direction of strict BP control with a new definition and universal target goal for hypertension will be the topic of debate among the guideline developing committee members of the Japanese Society of Hypertension.2Evidence in support of this change to a lower threshold (130/80 mm Hg) has been provided by recent publications, including SPRINT (Systolic Blood Pressure Intervention Trial) and The Lancet 2016 meta-analysis of randomized controlled trials of antihypertensive medications.3,4 In The Lancet meta-analysis, a BP reduction of ≈25% was shown to be of benefit in preventing cardiovascular events, especially stroke and heart failure, among people with a baseline systolic BP of ≥130 mm Hg. In SPRINT, automated office BP measurement without study personnel present in the room with the patient was conducted in some centers, which could yield BP values 10 to 15 mm Hg lower than BPs taken by routine clinical measurement. Thus, the achievement of strict systolic BP control of 120 mm Hg is postulated to be comparable to 130 to 135 mm Hg by routine clinical assessment. Accordingly, …