6 People with any degree of hypertension should be treated with nonpharmacologic interventions plus pharmacotherapy as needed to reach their BP goal.1-3.1 Understanding Hypertension What Is Hypertension? A direct relationship between increasing levels of blood pressure (BP) and increasing clinical morbidity and mortality has been recognized at least since the 1920s. Rigorously tested and effective BP treatments began to emerge in the 1960s and 1970s.1-Introduction Meta analysis of more than 60 prospective studies revealed a log-linear relationship between risk of cardiovascular disease (CVD) and both increasing levels of systolic blood pressure (SBP) and increasing levels of diastolic blood pressure (DBP). There is no “safe” level of uncontrolled hypertension.1-2.1 An elevated BP increases one’s risk of death from stroke, heart disease or other vascular disease.1-2.1 Heightened SBP and DBP are independently associated with increased risk of CVD incidence, angina, myocardial infarction (MI), heart failure (HF), stroke, peripheral artery disease (PAD) and abdominal aortic aneurysm (AAA). There are similar associations across broad age ranges less than 80 years, in both men and women, in multiple racial and ethnic categories and with a wide variety of comorbid conditions. The higher one’s BP, the higher one’s risk of CVD, ischemic disease and premature death.1-2.1 The current 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 replaced prior Joint National Committee (JNC) reports and has been updated by research in certain areas. The target BP for most adults who have been diagnosed with high blood pressure is <130/80 mm Hg regardless of age, sex, comorbidities, medications, race, ethnicity or other factors. A lower BP is better for reducing one’s risk of cardiovascular and other events.1-3.1 All BP measurements are based on an average of two careful readings obtained on at least two occasions.1-4.1.1 BP can be categorized into four levels.1-3 Table 6 BP CATEGORY BP (MM HG) SBP DBP NORMAL <120 and <80 ELEVATED 120-129 and <80 STAGE 1 HYPERTENSION 130-139 or 80-89 STAGE 2 HYPERTENSION ≥140 or ≥90
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