Kevin Maki, PhD: The Impact of the New AHA/ACC Hypertension Guidelines

Kevin Maki, PhD, the chief scientist at the Midwest Biomedical Research Center for Metabolic and Cardiovascular Health, sat down with MD Magazine to discuss the impact that the new guidelines for hypertension from the American Heart Association (AHA) and the American College of Cardiology (ACC) will have on patients and physicians.

Recently, the AHA/ACC updated the guidelines for treating hypertension (high blood pressure) in November 2017, with Stage 1 hypertension now being defined as a patient having systolic blood pressure between 130-139 or diastolic blood pressure between 80-89, shifting from the previous threshold of 140/90 mm Hg.

Maki, an expert in lipidology, spoke about how the new guidelines mirror the lipid guidelines, and how the need to treat threshold being lowered is ultimately a good thing.

Kevin Maki, PhD, the chief scientist at the Midwest Biomedical Research Center for Metabolic and Cardiovascular Health :

Well, I think with modifiable risk factors—and the big modifiable risk factors are high cholesterol, high blood pressure, smoking, and also diabetes (although the evidence there for glycemic control, per say, lowering cardiovascular risk is a little less compelling than the data for cholesterol lowering, for blood pressure lowering, for smoking cessation).

With those big 3 modifiable risk factors, I think it is not only the level of the risk factor, it is the length of the exposure. We, by lowering the threshold to consider therapies—and lifestyle therapies are incredibly important not only because they are, of course, low cost, but because they can be implemented early. Even if they have only a modest effect, that modest effect can be maintained over decades.

It is really important to identify early people with elevations in modifiable risk factors and then intervene early. That does not always mean pharmacological therapy. In certain cases, if the risk is high enough, the risk-benefit ratio favors pharmacologic therapy, but lifestyle therapies are important. They get kind of short shrift in clinical practice often.

By identifying people earlier in the process, I think we will have better ultimate results because the clinical trial data really show that for lipid-lowering, lower is better and lower is better for longer, and now with blood pressure, we are seeing that the prior targets probably were not giving us all of the benefits that could be obtained with lower targets.