An updated guideline for high blood pressure (BP) in adults has been released. BP progressively increases with age. Observational studies have demonstrated graded associations between higher systolic BP (SBP) and diastolic BP (DBP) and increased risk of cardiovascular disease (CVD), particularly above a BP of 120/80 mm Hg. However, after consideration of SBP through adjustment or stratification, DBP has not been consistently associated with CVD risk. BP is categorized into 4 levels on the basis of average BP measured in a healthcare setting (office pressures): normal, elevated, and stage 1 or 2 hypertension, with stage 1 hypertension now defined as an SBP of 130–139 or a DBP of 80–89 mm Hg. Accurate measurement and recording of office and out-of-office BPs are essential to categorize level of BP, ascertain BP-related CVD risk, and guide management of high BP. Lifestyle modification is the cornerstone of the treatment of hypertension, including weight loss, a healthy diet, sodium reduction, enhanced potassium intake (preferably dietary), exercise, and moderate alcohol intake. Use of a combination of absolute CVD risk and BP level to guide treatment is more efficient and cost effective at reducing risk of CVD than is use of BP level alone. The first-line agents include thiazide diuretics, calcium channel blockers, and angiotensin-converting-enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs). Simultaneous use of an ACE inhibitor, ARB, and/or renin inhibitor is potentially harmful and is not recommended. Source: http://hyper.ahajournals.org/
