In the previous guidelines, a systolic blood pressure of 140 mm Hg or higher or a diastolic blood pressure of 90 mm Hg and above were the thresholds to initiate medications for primary prevention. The new guidelines recommend drug therapy if blood pressure remains at or above 130/80 mm Hg after 3-6 months of lifestyle changes such as eating a healthier diet.
Antihypertensive medications should begin right away in adults with hypertension with diabetes or chronic kidney disease or an elevated 10-year risk of cardiovascular disease, per the guidelines. The cardiovascular disease risk calculation should be based on the PREVENT risk calculator published by the AHA in 2023.
The guidelines also call for screening for primary aldosteronism in patients with resistant hypertension, regardless of whether they have hypokalemia.
The document also makes two “important” changes to laboratory testing: testing the ratio of urine albumin and creatinine for all patients with high blood pressure — which formerly was considered an optional test — and developing tailored approaches to medication for high blood pressure.
The new guidelines suggest patients discuss renal denervation with their clinicians as a way to reduce the need for medication, but the document falls short of recommending the procedure.
The 2017 guidelines advised no more than 2300 mg of sodium intake per day; now the recommendation is to cap sodium at 1500 mg per day. And people who want to prevent or manage hypertension should not drink alcohol at all, according to the new guidelines.
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