Do I need antihypertensive drugs for blood pressure> 130/80mmHg? U.S. Issues Scientific Statement

my country's guidelines recommend that on the basis of improving lifestyle, hypertensive patients should start drug therapy if their blood pressure is still ≥140/90 mmHg and/or higher than the target blood pressure. In clinical practice, there are still many patients with blood pressure of 130–139/80–89 mmHg. Do they need to take antihypertensive drugs?

Recently, the American Heart Association (AHA) released a scientific statement on patients with grade 1 hypertension (130–139/80–89 mmHg) at low 10-year atherosclerotic cardiovascular disease (ASCVD) risk. Management made practical recommendations to fill in the guidance gaps.

html Grade 31 hypertension is prevalent in young and middle-aged adults, and most develop Grade 2 hypertension with further elevated cardiovascular risk. A Chinese study showed that 65% of patients with grade 1 hypertension aged 35-59 developed grade 2 hypertension within 15 years. In addition, more than 26% of all cardiovascular deaths were attributable to grade 1 hypertension. The

2017 American Hypertension Practice Guidelines recommend lifestyle interventions for patients with grade 1 hypertension (130–139/80–89 mmHg) with ASCVD risk <10%,>

states that patients with grade 1 hypertension with an untreated 10-year risk of atherosclerotic cardiovascular disease (ASCVD) <10%>

For patients with grade 1 hypertension who do not meet the target within 6 months, lifestyle interventions should be continued and drug therapy should be considered, including CCB, ACEI, ARB and diuretics.For young adults with grade 1 hypertension who have not received lifestyle interventions, if they have a family history of cardiovascular disease, gestational hypertension, or a history of premature birth (I belong to a premature infant), antihypertensive drugs should be considered .

For patients diagnosed with hypertension in adolescence or childhood and receiving drug therapy, the original indications for initiation of drug therapy should be considered, and lifestyle interventions and drug therapy should be continued in adulthood.

In addition, according to the 2019 ACC/AHA Guidelines for Primary Prevention of Cardiovascular Disease, 10-year risk should be reassessed every 4-6 years for those with 10-year ASCVD risk <10%.>

Hebei Provincial People's HospitalProfessor Guo Yifang believes that research evidence supporting active blood pressure has been increasing in recent years, and this guideline document follows this general trend and conducts low-risk individuals with blood pressure levels of 130-139/80-89mmHg. It is reasonable to propose more active drug intervention suggestions, and it also has good reference significance for clinical practice in my country.

Bibliography: Daniel W Jones, Paul K Whelton, Norrina Allen, et al. 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. Hypertension. 2021 Apr 29.