Editorials

Blood pressure guidelines as starting point in clinical decisions

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.j5862 (Published 02 January 2018) Cite this as: BMJ 2018;360:j5862
  1. Harlan M Krumholz, Harold H Hines Jr professor
  1. Yale Schools of Medicine and Public Health, New Haven, CT, USA
  1. harlan.krumholz{at}yale.edu

Debate about individual targets should not distract us from eliminating severe hypertension

At the annual scientific sessions of the American Heart Association in November 2017, prominent US organisations released an update of the national blood pressure guidelines.1 The document was endorsed by 11 groups representing various healthcare professional and public health organisations, including the American Heart Association and the American College of Cardiology. This update is the next iteration of the Joint National Committee series that was formerly released by the US National Institutes of Health.

Among the recommendations in the guideline, the classification of blood pressure drew the most attention. On the basis of blood pressure measured in healthcare settings, people with a systolic blood pressure of 120-129 mm Hg and a diastolic blood pressure <80 mm Hg are now labelled as having raised blood pressure. Stage 1 hypertension is now defined as 130-139 mm Hg or a diastolic blood pressure of 80-89 mm Hg. Stage 2 hypertension is now defined as ≥140 mm Hg or ≥90 mm Hg. Drug treatment is recommended for people with cardiovascular disease (defined as coronary heart disease, heart failure, or stroke), or chronic kidney disease or …

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