Blood Pressure Management: Beyond the Guidelines.

Abstract

See related article, pp e13–e115 Since 1977, national blood pressure (BP) management guidelines have served the medical community and patients well.1 Implementation of these guidelines has contributed to a decline in the mean BP level in the United States and to a remarkable reduction in age-adjusted cardiovascular disease (CVD) mortality rates.2 However, the decline in CVD death rates has leveled in the past 5 years, and CVD remains the leading cause of death in the United States and most industrialized countries. These trends are cause for concern because they indicate we are losing some progress toward achieving the ultimate goal of the American Heart Association, as expressed in its mission statement: Building healthier lives, free of cardiovascular diseases and stroke.3 Although management of other risk factors is a part of the picture, perhaps the largest opportunity for moving toward that goal can be found in effective BP management. Could we better equip ourselves to address cardiovascular disease by focusing on the issues involved in the residual risk of elevated BP? Certainly, some of the residual risk lies in nonadherence to treatment. But, let us examine the residual risk from the current approach to BP goals of therapy. The 2017 American College of Cardiology/American Heart Association Blood Pressure Management Guideline begins the process of addressing the need for more progress in reducing CVD events and deaths by implementing lower goal BP based on the best available evidence from randomized controlled trials (RCTs).1 Effective implementation of the new systolic BP (SBP) goal …