Top Things to Know: Management of Stage 1 Hypertension in Adults With a Low 10-Year Risk for Cardiovascular Disease

Published: April 29, 2021

Prepared by Anne Leonard MPH, BSN, RN, FAHA Sr. Science and Medicine Advisor

  1. High blood pressure (BP) is the leading cause for world-wide cardiovascular disease (CVD) morbidity and mortality. The global prevalence of systolic blood pressure levels greater than 110 mmHg increased over the last 30 years and was responsible for 10 million deaths and 212 million Disability-Adjusted Life Years worldwide in 2015.
  2. Worldwide this represents a 1.4-fold increase since 1990.
  3. Among middle aged adults, every 20 mmHg increase in SBP is associated with a doubling in the rate of death from stroke, ischemic heart disease and other vascular causes of death. Individuals with hypertension have higher lifetime risks for CVD and experience the onset of CVD morbidity 5 years earlier than individuals with normal BP.
  4. This statement provides complementary information to the 2017 AHA/ACC Blood Pressure Management Guidelines for the patient with untreated stage 1 hypertension (systolic blood pressure (SBP)/diastolic blood pressure (DBP) 130-139/80-89mmHg with a 10-year risk for atherosclerotic cardiovascular disease (ASCVD) lower than 10% who fail to meet the SBP/DBP goals of <130/80mmHg after 6 months of guideline recommended lifestyle therapy.
  5. Blood pressure levels above what is considered normal, i.e. >120/80 mmHg, in early adulthood are associated with higher long-term risk for CVD even if their calculated 10-year risk is low. Stage 1 hypertension is common among young and middle-aged adults and many will develop stage 2 hypertension and a higher risk of ASCVD.
  6. There is a lack of randomized clinical trials that have evaluated CVD outcomes among individuals with stage 1 hypertension and a low 10-year ASCVD risk.
  7. The 2017 AHA/ACC Hypertension Guidelines recommend as first line recommendations, lifestyle changes including a healthier diet, reduced sodium intake, enhanced potassium intake, increased physical activity and abstinence or moderation in alcohol intake for prevention and treatment.
  8. In patients with stage 1 hypertension not achieving a goal BP of <130/80mmHg within 6 months of recommended changes, lifestyle therapy should continue and then consideration given to the addition of medication from the four classes recommended in the 2017 Hypertension Guideline.
  9. For patients who are identified as having hypertension during adolescence (or childhood) and prescribed antihypertensive drug therapy, consideration should be given to the original indications for starting drug treatment and the need to continue antihypertensive medication and lifestyle therapy as young adults.
  10. In young adults with stage 1 hypertension who are not controlled with lifestyle therapy, special consideration should be given to use of antihypertensive medication with careful consideration of individuals with a family history of premature CVD; a history of hypertension during pregnancy, or a personal history of premature birth.
  11. Careful attention should be paid to adherence for both non-pharmacologic (lifestyle) modification and pharmacologic therapy in young adults with stage 1 hypertension.
  12. Suggestions for future research and the need for appropriate clinical trials are given in this paper.

View the summary for Management of Stage 1 Hypertension in Adults With a Low 10-Year Risk for Cardiovascular Disease

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Citation

Jones DW, Whelton PK, Allen N, Clark D 3rd, Gidding SS, Muntner P, Nesbitt S, Mitchell NS, Townsend R, Falkner B; on behalf of the American Heart Association Council on Hypertension; Council on the Kidney in Cardiovascular Disease; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular Radiology and Intervention; Council on Lifelong Congenital Heart Disease and Heart Health in the Young; and Stroke Council. 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 [published online ahead of print April 29, 2021]. Hypertension. 2021. doi: 10.1161/HYP.0000000000000195

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