2017 AHA/ACC Updates and Guidelines

In November 2017 the American Heart Association (AHA) announced changes to the definition and classification of hypertension. The new guidelines serve as a successor to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure issued in 2003.

The 2017 ACC (American College of Cardiology) /AHA guidelines recommend establishing Blood Pressure (BP) levels on the basis of the average of 2-3 readings on at least 2 different occasions, classifying BP into 4 categories (see table). The new guidelines lower the threshold for disease detection, emphasize the importance of out-of-office BP measurements to confirm diagnosis and titration of BP lowering medication while establishing a BP target of less than 130/80 mmHG for selected patients.

Current Categories of Hypertension

According to this new classification, the number of adults in the US who are not aware, not treated, or do not have their high blood pressure well controlled will swell to more the 50 million people. Roughly 1 in 4 of all men and 1 in 5 of all women older than 20 years. This number translates into an enormous opportunity for oral healthcare providers to become involved with screening and monitoring BP. The literature has shown us that dentists, physicians and patients are receptive to screening for medical conditions, and several sources show that many patients are unaware of their medical health while visiting the dentist. Regular BP measurements accomplished during dental visits will allow for patient-provider conversations to help create awareness, educate the patient, and discuss potential risks (i.e. the association with elevated BP and cardiovascular disease, stroke, heart failure and chronic renal disease).  These interactions will allow the practitioner to discuss whether the patient is performing routine out of office BP measurements, maintaining a heart- healthy diet and regularly exercising.  These measures have all been shown to improve quality of life and our encouraged by the AHA. The ACC/AHA changes will affect many people (for example, 46%of the US adult population now will be classified as having hypertension) and will change medicine and dentistry in some unique ways.

The new guidelines also emphasize a 2 fold approach to tighter BP medication control with initiation of blood pressure lowering drug therapy for those at high risk of developing CVD (cardiovascular disease) at a level of 130/80.  For patients who are at a low risk for CVD, drug therapy is recommended at a level of 140/90.  Providers are encouraged to utilize the atherosclerotic cardiovascular disease risk calculator to asses the risk of a patient developing heart disease or stroke within 10 years.

Atherosclerotic risk calculator (Clickable link)

The risk of developing cardiovascular disease already starts at at BP of 115/75 and doubles for every incremental increase of 20/10 mmHG. Of note, the systolic  BP rather than the diastolic BP is associated with a greater risk of developing CVD. These new guidelines do not change the approach to the question “at what level of blood pressure is it unsafe to treat our dental patients.”  The 2017 ACC/AHA  still state that uncontrolled blood pressure at  180/110 mmHG or greater is classified as a minor risk condition when planning surgical treatments.  We will discuss this in more detail below, but it is important to remember the ACC/AHA 2007 guidelines include a statement that BP should be brought under control before any surgery is performed, and because most dental treatment is elective the recommendation is to defer care with BP measurements at or greater than 180/110 mmHG.

If you would like to learn more, check out our continuing education courses free of charge at swosstaging.wpengine.com/CE.  A great way to stay current on information important to you  and your patients.