PM&R News   •   December 2017

To start the new year off right, we thought we would kick start your learning by brushing up on your hypertension management.  The 2017 clinical practice guidelines for hypertension were just published and have a few different recommendations from previous years. These guidelines are recommendations that all physiatrists should be aware of so let’s go over some of those differences.

The new guidelines now define SBP of 130-139 mmHg or DBP of 80-89 mmHg as stage I hypertension. Individuals with blood pressure in the above range have a 2 fold increase of cardiovascular disease. If your patient is high risk for atherosclerotic cardiovascular disease medical management should begin in Stage I as opposed to lifestyle management for those low risk.  If your patient is >64, you should begin medical management for stage I hypertension as well.

Another difference in the new guidelines is that irrespective of risk, the goal of treatment is blood pressure lower than 130/80. If blood pressure is sufficiently elevated, two drugs should be started initially. They recommend calcium channel blockers or thiazides as first line medications for monotherapy, but also suggest ace inhibitors and angiotensin receptor blockers could be used.

The new guidelines suspect a 14% increase in prevalence with a goal of significant reduction in cardiovascular disease. As technology continues to evolve, it will be interesting to see the incorporation of devices to record blood pressure throughout the entire day to help tailor medications to each particular patient.