Are the American Heart Association/American college of cardiology high blood pressure guidelines fit for global purpose? Thoughts from the international society of hypertension

Abstract

On the basis of currently available evidence, 1. We welcome the increased emphasis on out-of-office BP measurement which the ACC/AHA guidelines provide, but advise caution on the reported equivalence levels by type of measurement. 2. We support the use of risk assessment recommended in the ACC/AHA guidelines but note that the levels recommended as defining high risk do not accurately match those used in SPRINT. 3. We welcome the increased awareness about the importance of raised BP which the ACC/AHA guidelines have raised. 4. We suggest that in the global context, the definition of hypertension should remain as systolic BP ≥140 mm Hg and diastolic BP ≥90 mm Hg. 5. We think that ideal systolic BP targets for those with or without diabetes mellitus should probably be 130 mm Hg. However, people with systolic BP in the range 130 to 139 mm Hg should receive nonpharmacological advice, and only where resources allow and for those at high cardiovascular risk should drug therapy be considered for such people.