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JAMA Cardiology Clinical Guidelines Synopsis
April 2018

The 2017 American College of Cardiology/American Heart Association Clinical Practice Guideline for High Blood Pressure in Adults

Author Affiliations
  • 1Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
  • 2Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
  • 3Department of Medicine, University of Virginia School of Medicine, Charlottesville
JAMA Cardiol. 2018;3(4):352-353. doi:10.1001/jamacardio.2018.0005

This guideline provides a new system for classification of blood pressure (BP) that identifies stage 1 hypertension as an average systolic BP (SBP) of 130 to 139 mm Hg or a diastolic BP (DBP) of 80 to 89 mm Hg and stage 2 hypertension as an average SBP of 140 mm Hg or greater or a DBP of 90 mm Hg or greater. It emphasizes accurately measuring BP, averaging readings, and using out-of-office BPs to confirm an office diagnosis and recognize white-coat or masked hypertension. Choosing antihypertensive drug therapy should be influenced by comorbidities with an indication to use an agent that concurrently lowers BP. Without an indication, initial therapy with a diuretic, calcium-channel blocker, angiotensin-converting enzyme inhibitor, or angiotensin receptor blocker is acceptable. The focus should be on BP control rather than therapy choice. Most adults requiring antihypertensive drug therapy should be treated initially with 2 agents, especially those who are African American or have stage 2 hypertension. The goal during hypertension treatment should be an SBP of less than 130 mm Hg and a DBP of less than 80 mm Hg (SBP <130 mm Hg in adults ≥65 years).

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