New ACC/AHA guidelines: Treat high BP early at 130/80 mm Hg rather than 140/90


Dr KK Aggarwal    04 January 2018

  • Seventeen people across 13 states, including one person in New York, have been affected by an E. coli diarrhea outbreak, according to the US Centers for Disease Control and Prevention (CDC).
  • What were the findings of the DUNE study (Meneghini et al) of achievement of individualized glycated hemoglobin (HbA1c) targets of 7.0% to 7.5% after 12 weeks of treatment with basal insulin in a real-world setting? The DUNE study had a large, real-world population of patients either newly initiated on basal insulin or who had taken it for less than 12 months. Only 27.4% of patients achieved the individualized HbA1c set by their physician, even though at 7.0% to 7.5% the targets were not stringent. This finding was consistent with other real-world data and highlights the lack of effective titration of insulin in the real world. A key finding was that participants who experienced symptomatic hypoglycemia were more likely to achieve their HbA1c target than those who did not.
  • A comparison of the 2016 US Preventive Services Task Force (USPSTF) recommendations for statin therapy and the 2013 ACC/AHA Guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults, showed that more patients would be recommended for statin therapy under the ACC/American Heart Association (AHA) guidelines, according to a study published April 18in JAMA. The 2013 ACC/AHA guidelines are based on an elevated 10-year risk of atherosclerotic cardiovascular disease (ASCVD), while the 2016 USPSTF recommendations for primary prevention statin therapy increased the estimated ASCVD risk threshold for patients (including those with diabetes) and required the presence of at least one cardiovascular risk factor (i.e., hypertension, diabetes, dyslipidemia, or smoking), in addition to elevated risk.
  • The ACC, with the American Heart Association (AHA) and the Heart Rhythm Society (HRS), released the first guideline for the evaluation and management of patients with syncope. The guideline was published March 9in the Journal of the American College of Cardiology.

o    If a patient faints, a physician should perform a detailed history and physical examination during the initial evaluation. Using an electrocardiogram during this time may be useful to determine the cause of fainting. People with serious medical conditions that could be related to their fainting should be evaluated and/or treated at a hospital after the initial assessment.

o    The guideline also explains that certain tests such as routine laboratory testing and routine cardiac imaging may not be useful in evaluating these patients unless the unless the patient has a suspected cardiac issue. Carotid artery or head imaging may not be useful unless there is a specific reason why the patient needs to be evaluated further.

o    Depending on the reason for fainting, treatment options may include implantable cardioverter-defibrillators (ICDs), beta-blockers or pacemakers. Patients who faint and who also have certain types of heart issues should restrict their exercise, and athletes who experience fainting should have a heart assessment done by an experienced health care provider or specialist before returning to competitive sports. Heart rhythm monitoring can be a good choice for patients with unexplained fainting who may have intermittent heart rhythm issues that cause fainting.

  • Patients with atrial fibrillation who are taking digoxin have an increased risk of death, whether or not they have heart failure, compared with patients not taking the drug. This risk increases with higher levels of digoxin in the bloodstream, according to research presented from the ARTISTOTLE trial by Renato Lopes, MD, PhD, FACC, on March 19at ACC.17, the annual meeting of the American College of Cardiology (ACC) in Washington, DC.
  • The addition of evolocumab, a PCSK9 inhibitor, to statin therapy over several years significantly reduced cardiovascular morbidity and mortality in patients with clinically evident atherosclerotic cardiovascular disease, according to results from the FOURIER trial presented on Friday, March 17 during the first Late Breaking Clinical Trial session of ACC.17 in Washington, DC and simultaneously published in the New England Journal of Medicine.
  • Treatment with a sodium glucose cotransporter-2 inhibitor (SGLT-2i) was associated with a marked reduction in hospitalization for heart failure vs treatment with other glucose-lowering drugs, according to research presented by Mikhail Kosiborod, MD, FACC, on March 19at  ACC.17 in Washington, DC.
  • Catheter ablation improved outcomes for patients with atrial fibrillation (AFib) and left ventricular dysfunction, compared to conventional drug treatment, based on results from the CASTLE-AF trial presented on Aug. 27at the ESC Congress 2017 in Barcelona.
  • High blood pressure (BP) should be treated earlier with lifestyle changes and in some patients with medication – at 130/80 mm Hg rather than 140/90 – based on new ACC/AHA guidelines for the detection, prevention, management and treatment of high blood pressure.

o    The new guidelines – the first comprehensive set since 2003 – lower the definition of high blood pressure to account for complications that can occur at lower numbers and to allow for earlier intervention. The new definition will result in nearly half of the U.S. adult population (46 percent) having high blood pressure, with the greatest impact expected among younger people. Additionally, the prevalence of high blood pressure is expected to triple among men under age 45, and double among women under 45. However, only a small increase is expected in the number of adults requiring antihypertensive medication.

  Dr KK Aggarwal

 Padma Shri Awardee Vice President CMAAO Group Editor-in-chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

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