Resistant Hypertension Now Starts at 130/80 mm Hg

Action Points

  • The American Heart Association (AHA) has released updated recommendations for diagnosis and management of resistant hypertension (RH), which is defined as blood pressure (BP) that remains at >130/80 mmHg despite concurrent treatment with three antihypertensive agents of different classes, at maximally tolerated doses.
  • Major changes in this first revision of the AHA’s initial 2008 scientific statement on hypertension include more specific diagnostic criteria for RH, acknowledgement of the importance of sleep duration and quality in BP control, and increased emphasis on early lifestyle measures regarding diet and physical activity.

Updated recommendations for the diagnosis and management of resistant hypertension (RH) have been released by the American Heart Association (AHA) that lower the threshold to 130/80 mm Hg.

The document is the first revision since the AHA’s initial 2008 scientific statement on hypertension, noted Robert M. Carey, MD, of the University of Virginia Health Sciences Center in Charlottesville, and colleagues.

The statement reflects the 2017 American College of Cardiology/AHA hypertension guidelines, which reduced BP thresholds for initiation of antihypertensive therapy in higher-risk adults to >130/80 mm Hg, and BP treatment goals to <130/80 mm Hg for most individuals.

Writing in Hypertension, the authors noted that RH, which affects an estimated 12% to 15% of individuals treated for high blood pressure (BP), is defined as BP that remains elevated above the target of 130/80 mm Hg despite concurrent treatment with three antihypertensive agents of different classes, at maximum or maximally tolerated doses and at the appropriate dosing frequency.

Other major changes include use of more specific diagnostic criteria for resistant hypertension, acknowledgement of the importance of sleep duration and quality in BP control, and increased emphasis on early lifestyle measures regarding diet and physical activity to prevent and treat resistant hypertension.

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