Management of Stage 1 Hypertension in Adults With a Low 10-Year Risk for Cardiovascular Disease: Filling a Guidance Gap: A Scientific Statement From the American Heart Association

Abstract

High blood pressure (BP) is the leading cause of worldwide cardiovascular disease morbidity and mortality. Patients and clinicians dealing with hypertension have benefited from the evidence of event-based randomized controlled clinical trials. One result from those trials has been the development of evidence-based guidelines. The commitment to using evidence from these event-based randomized trials has been a cornerstone in the development of guideline treatment recommendations. However, in some situations, evidence from event-based trials is not available to guideline writers or clinicians for assistance in treatment decision making. Such is the case for the management of many patients with stage 1 hypertension. The purpose of this scientific statement is to provide information complementary to the 2017 Hypertension Clinical Practice Guidelines for the patient with untreated stage 1 hypertension (systolic BP/diastolic BP, 130–139/80–89 mm Hg) with a 10-year risk for atherosclerotic cardiovascular disease <10% who fails to meet the systolic BP/diastolic goal (<130/80 mm Hg) after 6 months of guideline-recommended lifestyle therapy. This statement provides evidence from sources other than event-based randomized controlled clinical trials and offers therapy options for consideration by clinicians.

Sex Differences in Temporal Trends of Cardiovascular Health in Young US Adults

“… 20 Currently, there is a lack of event‐based evidence on the clinical benefits of antihypertensive treatment in a low‐risk group. 21 The current BP guideline recommends pharmacological interventions and lifestyle modifications for adults with stage 1 hypertension based on an estimated 10‐year atherosclerotic CVD risk threshold of 10%. 22 As young adults generally have low 10‐year risk, the low use of antihypertensive medications, and therefore low rate of optimal BP control, is unsurprising.…”

Hypertension Defined by 2017 ACC/AHA Guideline, Ideal Cardiovascular Health Metrics, and Risk of Cardiovascular Disease: A Nationwide Prospective Cohort Study

“… 28 However, there has been less consistency regarding the need for antihypertensive drug treatment in patients with stage 1 hypertension, especially younger adults who would most likely have low predicted 10-year ASCVD risk regardless of risk factor burden. 29 By using cardiovascular health rather than predicted ASCVD risk to further stratify younger participants with stage 1 hypertension, we demonstrated that adults <60 years of age with stage 1 hypertension who had ≥4 ICVHMs could be considered at a low CVD risk and preventive efforts might be implemented in young stage 1 hypertensive patients with a less number of ICVHMs.…”

The Effect of Exercise on Cardiometabolic Risk Factors in Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis

“…In clinical practice, maintaining systolic blood pressure below 130 mmHg is the primary goal for individuals with, or at risk of, hypertension. To this end, lifestyle modification involving diet modulation and increased physical activity is the first line of therapy [48]. The results of this study show that exercise was associated with only modest non-significant reductions in systolic blood pressure when compared with control.…”