I'll outline the main things for us A&P professors to know here, but do check out the resources I've linked below to deepen your understanding of current thinking regarding approaches to blood pressure (BP) health.
First, there are revised guidelines as to what constitutes high blood pressure or HTN:
- Normal BP: Less than 120/80 mm Hg;
- Elevated BP: Systolic between 120-129 and diastolic less than 80;
- Stage 1 HTN: Systolic between 130-139 or diastolic between 80-89;
- Stage 2 HTN: Systolic at least 140 or diastolic at least 90 mm Hg;
- Hypertensive crisis: Systolic over 180 and/or diastolic over 120, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage.
Regardless of the precise cutoffs listed above, in an interview discussing the new guidelines, the main author states that, "120/80 is normal, the same as we had before" the new guidelines. So I think we're safe in using 120/80 as an example of BP when discussing the normal science, even though technically it could be designated as "elevated." Not that we can't use an elevated variable measurement as an example when discussing the physiology of anything. The fact that even the main author of the guidelines uses 120/80 as the starting point of discussion makes me feel more confident in using it as the starting point of my course discussions, too.
The main thing to note in the categories above is that the cutoffs for HTN categories have been lowered. This puts many more people in an HTN category that were not there before. The main goal is for those folks to have conversations with their physicians to evaluate their risk for complications and develop a personalized prevention and care plan.
Note also that the category of prehypertension has been eliminated.
The new guidelines also recommend prescribing medication for Stage 1 HTN if the patient already had a cardiovascular event—or is at a high risk for such an event. They also recognize that many patients will need more than one medication to manage BP and that combining meds into one pill is likely to help folks take them consistently.
There are a lot of other recommendations, so reviewing the Executive Summary or similar resource (see below) may be a good idea.
What can we use from this in teaching undergraduate A&P?
- If you discuss hypertension, or use case studies in teaching, you need to update the cutoff BPs you are using.
- A BP of 120/80 is still considered the starting point for discussing blood pressure.
- Consider discussing the impact of the changes in the new guidelines for ordinary people.
- Discuss why such diagnosis, prevention, and treatment recommendations often change over time. Consider discussion other recent clinical updates.
- Consider discussing specific changes suggested in the new guidelines.
- Consider having students explore the Executive Summary and/or other documents and write their own summary or interpretation of key points. Perhaps they can create their own chart or concept map.
Need some free teaching materials?
SLIDE SET: High Blood Pressure
- Kevin Patton. Lion Den Slide Collection. 18 Nov 2017
- Small slide deck that includes an animated version of the BP Category chart pictured above. Part of the Lion Den Slide Collection (requires free registration to download). You can also download a static PNG image file of the chart in the slide collection set.
- my-ap.us/2ivoql5
- America Heart Association. 13 Nov 2017.
- Free video (viewable in the player above) features a chat with the main author of the new guidelines and summarizes the main points. Very practical and easy to understand.
- youtu.be/rvYL-7ergDs
SLIDE SET: 2017 Guideline For the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults
- American College of Cardiology. 13 Nov 2017
- Free set of almost 100 PowerPoint slides to use in teaching. And it has a decided focus on clinical applications, rather than the basic science. These are way, way beyond the coverage desirable in an undergrad A&P course. But some slides may be useful to you.
- my-ap.us/2itMBjY
Want to know more?
New blood pressure guidelines put half of U.S. adults in unhealthy range
- A. Cunningham Science News. 13 Nov 2017
- Plain-English article summarizing the first major update since 2003 aims to spur heart-healthy lifestyle changes. Has a useful graph and links to other articles and resources.
- my-ap.us/2itVnOR
New Multisociety Hypertension Guideline Is Released
- Allan S. Brett, MD reviewing Whelton PK et al. J Am Coll Cardiol 2017 Nov 13. NEJM Journal Watch Nov 2017.
- Brief review of the larger report (listed below), summarize key take-away points.
- my-ap.us/2iumCc1
2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary
A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
- PK Whelton et al. Hypertension, Dec 2017, Volume 70, Issue 6. DOI: 10.1161/HYP.0000000000000066
- Free PDF of the Executive Summary of the larger report. I recommend reading this first, then decide if you need to read the whole report.
- my-ap.us/2iuzvCT
2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults
A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
- PK Whelton et al. Hypertension. Dec 2017, Volume 70, Issue 6. DOI: 10.1161/HYP.0000000000000065
- Free PDF of the entire report. It's huge, so make a whole pot of tea before starting it.
- my-ap.us/2irTUZj
Potential U.S. Population Impact of the 2017 American College of Cardiology/American Heart Association High Blood Pressure Guideline
- Paul Muntner et al. Journal of the American College of Cardiology. November 2017. DOI: 10.1016/j.jacc.2017.10.073
- Free abstract briefly outlines the impact of the new HTN guidelines.
- my-ap.us/2iu8BLi
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