BP Meds Should Begin Promptly, New ACC/AHA Guidelines Say

The target blood pressure level for adults remains below 130/80 mm Hg, but drug therapy should be initiated sooner, according to new guidelines published Thursday by the American Heart Association (AHA) and American College of Cardiology (ACC). Eleven other medical organizations endorsed the new guidelines, which replace those issued in 2017.

“We’re trying to get started earlier in the process of preventing cardiovascular disease,” said Daniel W. Jones, MD, dean and professor emeritus of the University of Mississippi School of Medicine in Jackson, who chaired the guidelines committee. 

Almost half of American adults have hypertension, according to the AHA.

In the previous guidelines, a systolic blood pressure of 140 mm Hg or higher or a diastolic blood pressure of 90 mm Hg and above were the thresholds to initiate medications for primary prevention. The new guidelines recommend drug therapy if blood pressure remains at or above 130/80 mm Hg after 3-6 months of lifestyle changes such as eating a healthier diet.

Antihypertensive medications should begin right away in adults with hypertension with diabetes or chronic kidney disease or an elevated 10-year risk of cardiovascular disease, per the guidelines. The cardiovascular disease risk calculation should be based on the PREVENT risk calculator published by the AHA in 2023. 

While the target blood pressure goal is below 130/80 mm Hg, Jones said clinicians should encourage patients to achieve readings lower than 120/80 mm Hg when possible. The AHA and ACC continue to recommend the heart-friendly DASH diet that emphasizes fruits, vegetables, fat free or low fat dairy products, fish, poultry, beans, and nuts.

Recent Research Spurred Review 

The new guidelines incorporate research about controlling high blood pressure from 2015 to 2024. One new focus this time is the link between high blood pressure and dementia.

“Lowering blood pressure in an intensive way reduces the risk of dementia,” Jones said. 

In addition to medication as appropriate, reducing salt intake, staying physically active, lowering weight, and managing stress can all blunt the risk for dementia, the authors of the guidelines found. Doing so would also reduce risks for heart attack, stroke, heart failure, and kidney disease, they noted.

The guidelines also call for screening for primary aldosteronism in patients with resistant hypertension, regardless of whether they have hypokalemia. 

The document also makes two “important” changes to laboratory testing: testing the ratio of urine albumin and creatinine for all patients with high blood pressure — which formerly was considered an optional test — and developing tailored approaches to medication for high blood pressure.

The new guidelines suggest patients discuss renal denervation with their clinicians as a way to reduce the need for medication, but the document falls short of recommending the procedure.

The 2017 guidelines advised no more than 2300 mg of sodium intake per day; now the recommendation is to cap sodium at 1500 mg per day. And people who want to prevent or manage hypertension should not drink alcohol at all, according to the new guidelines. 

Men who drink should limit their intake to two alcoholic beverages per day; women to one. That’s a daily limit, not a rolling average, Jones stressed. Saving drinks for the weekend is not a thing when blood pressure management is concerned.

“Losing weight lowers blood pressure,” added Jones, who encouraged patients to consider using a GLP-1 inhibitor when clinically appropriate. Women who are pregnant or expecting to become pregnant should consider using low-dose aspirin to prevent risk of preeclampsia, the guidelines state.

“High blood pressure during pregnancy predicts high blood pressure for the rest of your life,” Jones said. Given this reality the new guidelines spend more time on pregnancy than the previous version, he said.

Marcus A. Banks, MA, is a journalist based near New York City who covers health news with a focus on new cancer research. His work appears in Medscape, Cancer Today, The Scientist, Gastroenterology & Endoscopy News, Slate, TCTMD, and Spectrum.