The ACC/AHA 2017 Hypertension Guidelines: Both Too Much and Not Enough of a Good Thing?
Authors: Jordana B. Cohen, Raymond R. Townsend
Journal: Annals of Internal Medicine (2017)

Ideas and Opinions20 February 2018The ACC/AHA 2017 Hypertension Guidelines: Both Too Much and Not Enough of a Good Thing?Jordana B. Cohen, MD, MSCE and Raymond R. Townsend, MDJordana B. Cohen, MD, MSCEUniversity of Pennsylvania, Philadelphia, Pennsylvania (J.B.C., R.R.T.)Search for more papers by this author and Raymond R. Townsend, MDUniversity of Pennsylvania, Philadelphia, Pennsylvania (J.B.C., R.R.T.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-3103 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail With the proliferation of hypertension guidelines in recent years, the 2017 guidelines from the American College of Cardiology and American Heart Association (ACC/AHA) (1) are a tour de force, encompassing an imposing 481 pages, 106 recommendations, 23 tables, and 11 figures and representing countless hours of systematic literature review. This level of meticulousness is not lost on those of us who spend our time contributing to and interpreting the hypertension literature. Nonetheless, the guidelines bombarded the intended audience—clinicians on the frontline of patient care—with a mountain of information that may have spawned as many questions as it answered.Intended as ...References1. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2017. [PMID: 29133356] doi:10.1161/HYP.0000000000000065 CrossrefMedlineGoogle Scholar2. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al; National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289:2560-72. [PMID: 12748199] CrossrefMedlineGoogle Scholar3. Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, et al. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999;282:1458-65. [PMID: 10535437] CrossrefMedlineGoogle Scholar4. Qaseem A, Wilt TJ, Rich R, Humphrey LL, Frost J, Forciea MA; Clinical Guidelines Committee of the American College of Physicians and the Commission on Health of the Public and Science of the American Academy of Family Physicians. Pharmacologic treatment of hypertension in adults aged 60 years or older to higher versus lower blood pressure targets: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Ann Intern Med. 2017;166:430-7. [PMID: 28135725]. doi:10.7326/M16-1785 LinkGoogle Scholar5. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311:507-20. [PMID: 24352797] doi:10.1001/jama.2013.284427 CrossrefMedlineGoogle Scholar6. Wright JT, Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV, et al; SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373:2103-16. [PMID: 26551272] doi:10.1056/NEJMoa1511939 CrossrefMedlineGoogle Scholar7. Bress AP, Tanner RM, Hess R, Colantonio LD, Shimbo D, Muntner P. Generalizability of SPRINT results to the U.S. adult population. J Am Coll Cardiol. 2016;67:463-72. [PMID: 26562046] doi:10.1016/j.jacc.2015.10.037 CrossrefMedlineGoogle Scholar8. McCarney R, Warner J, Iliffe S, van Haselen R, Griffin M, Fisher P. The Hawthorne effect: a randomised, controlled trial. BMC Med Res Methodol. 2007;7:30. [PMID: 17608932] CrossrefMedlineGoogle Scholar9. Cushman WC, Evans GW, Byington RP, Goff DC, Grimm RH, Cutler JA, et al; ACCORD Study Group. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010;362:1575-85. [PMID: 20228401] doi:10.1056/NEJMoa1001286 CrossrefMedlineGoogle Scholar10. Townsend RR, Taler SJ. Management of hypertension in chronic kidney disease. Nat Rev Nephrol. 2015;11:555-63. [PMID: 26215512] doi:10.1038/nrneph.2015.114 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of Pennsylvania, Philadelphia, Pennsylvania (J.B.C., R.R.T.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-3103.Corresponding Author: Jordana B. Cohen, MD, MSCE, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19103; e-mail, [email protected]upenn.edu.Current Author Addresses: Drs. Cohen and Townsend: University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19103.Author Contributions: Drafting of the article: J.B. Cohen, R.R. Townsend.Critical revision for important intellectual content: R.R. Townsend.Final approval of the article: J.B. Cohen, R.R. Townsend.This article was published at Annals.org on 5 December 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byThe ratio FEV 1 /FVC and its association to respiratory symptoms—A Swedish general population studyAge and sex specific target of blood pressure for the prevention of cardiovascular event among the treatment naive hypertensive patientsStart und Ziele der BlutdrucktherapieGuidelines for hypertension management in primary care: is local adaptation possible?The Story of the Silent KillerPrevalence and Predictors of High Blood Pressure Among Women of Reproductive Age and Children Aged 10 to 14 Years in GuatemalaHemodynamic Instability in Heart Failure Intensifies Age-Dependent Cognitive DeclineObesity-related hypertension: Findings from The Korea National Health and Nutrition Examination Survey 2008–2010Stage 1 hypertension by the 2017 American College of Cardiology/American Heart Association hypertension guidelines and risk of cardiovascular disease events: systematic review, meta-analysis, and estimation of population etiologic fraction of prospective cohort studies130/80 is the new 140/90: Do we need a tailored approach for older patients?Nutrition intervention in heart failure: should consumption of the DASH eating pattern be recommended to improve outcomes?The new US and European guidelines in hypertension: A multi-dimensional analysisHypertension Guidelines: Effect of Blood Pressure TargetsBlood Pressure Control and Cardiovascular Outcomes: Real-world Implications of the 2017 ACC/AHA Hypertension GuidelineThe new hypertension guideline: logical but unwiseThe American College of Cardiology/American Heart Association 2017 hypertension guideline: Implications for incorporation in Latin America, the Caribbean, and other resource-limited settingsDo hypertension guidelines put the person first?Barriers to Accurate Blood Pressure Measurement in the Medical Office 20 February 2018Volume 168, Issue 4Page: 287-288KeywordsCardiovascular diseasesComplex systemsDrug therapyHealth careHealth insuranceHealth surveysHeartHypertensionSystematic reviewsTreatment guidelines ePublished: 5 December 2017 Issue Published: 20 February 2018 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...