Feature Article| Volume 15, ISSUE 1, P102-109, January 2019

Reaching for Goal: Incorporating the Latest Hypertension Guidelines Into Practice

Published:November 21, 2018DOI:


      • Redefining hypertension
      • Risk assessment
      • Strategies to achieve BP goal


      Hypertension accounts for more cardiovascular disease deaths than any of the other modifiable risk factors. Despite the known benefits of lowering blood pressure, more than half of adults taking antihypertensive medications have blood pressures above current treatment goals. The purpose of this article is to inform nurse practitioners of the key highlights in the updated hypertension guidelines and provide guidance on incorporating the best available evidence into hypertensive care management.


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        • Whelton P.K.
        • Carey R.M.
        • Aronow W.S.
        • et al.
        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. A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
        J Am Coll Cardiol. 2017; 71: e127-e248
        • Benjamin E.J.
        • Virani S.S.
        • Callaway C.W.
        • et al.
        Heart disease and stroke statistics 2018 update. A report from the American Heart Association.
        Circulation. 2018; 137: e1-e134
        • American College of Cardiology
        Guidelines Made Simple. 2017 Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults.
        2018 (Accessed November 12, 2018)
        • Wright J.T.
        • Williamson J.D.
        • Whelton P.K.
        • et al.
        A randomized trial of intensive versus standard blood-pressure control.
        N Engl J Med. 2015; 373: 2103-2116
        • Carey R.M.
        • Whelton P.K.
        The 2017 American College of Cardiology/American Heart Association hypertension guideline: a resource for practicing clinicians.
        Ann Intern Med. 2018; 68: 359-360
        • Muntner P.
        • Carey R.M.
        • Gidding S.
        • et al.
        Potential US population impact of the 2017 ACC/AHA high blood pressure guideline.
        Circulation. 2018; 137: 109-118
        • Kullo I.J.
        • Trejo-Gutierrez J.F.
        • Lopez-Jimenez F.
        • et al.
        A perspective on the new American College of Cardiology/American Heart Association guidelines for cardiovascular risk assessment.
        Mayo Clin Proc. 2014; 89: 1244-1256
        • American College of Cardiology
        ASCVD Risk Estimator Plus.
        2018 (Accessed November 12, 2018)
        • Hinderliter A.L.
        • Sherwood A.
        • Craighead L.W.
        • et al.
        The long-term effects of lifestyle change on blood pressure: one-year follow-up of the ENCORE study.
        Am J Hypertens. 2014; 27: 734-741
        • Wasfy M.M.
        • Baggish A.L.
        Exercise dose in clinical practice.
        Circulation. 2016; 133: 2297-2313
        • Braam B.
        • Taler S.J.
        • Rahman M.
        • et al.
        Recognition and management of resistant hypertension.
        Clin J Am Soc Nephrol. 2017; 12: 524-535
        • Carey R.M.
        • Calhoun D.A.
        • Bakris G.L.
        • et al.
        Resistant hypertension: detection, evaluation, and management. A scientific statement from the American Heart Association.
        Hypertension. 2018; 72 (e000–e000.
        • Rimoldi S.F.
        • Scherrer U.
        • Messerli F.H.
        Secondary arterial hypertension: when, who, and how to screen?.
        Eur Heart J. 2014; 35: 1245-1254
        • Ahmad M.
        • Makati D.
        • Akbar S.
        Review of and updates on hypertension in obstructive sleep apnea.
        Int J Hypertens. 2017; : 1-13
        • Lei Q.
        • Lv Y.
        • Li K.
        • et al.
        Effects of continuous positive airway pressure on blood pressure in patients with resistant hypertension and obstructive sleep apnea: a systematic review and meta-analysis of six randomized controlled trials.
        J Bras Pneumol. 2017; 43: 373-379
        • Bratton D.J.
        • Stradling J.R.
        • Barbé F.
        • et al.
        Effect of CPAP on blood pressure in patients with minimally symptomatic obstructive sleep apnoea: a meta-analysis using individual patient data from four randomised controlled trials.
        Thorax. 2014; 69: 1128-1135
        • Aronow W.S.
        • Fleg J.L.
        • Pepine C.J.
        • et al.
        ACCF/AHA expert consensus document on hypertension in the elderly. A report of the American College of Cardiology Foundation Task force on clinical expert consensus documents.
        Circulation. 2011; 123: 2434-2506
        • Weiss J.
        • Freeman M.
        • Low A.
        • et al.
        Benefits and harms of intensive blood pressure treatment in adults aged 60 years or older.
        Ann Intern Med. 2017; 166: 419-429
        • Cushman W.C.
        • Johnson K.C.
        The 2017 U.S. hypertension guidelines: what is important for older adults?.
        J Am Geriatr Soc. 2018; 66: 1062-1067
        • Pickering T.G.
        • Hall J.E.
        • Appel L.J.
        • et al.
        Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research.
        Circulation. 2005; 111: 697-716
        • Parati G.
        • Ochoa G.E.
        • Bilo G.
        Role of office blood pressure in diagnosis and treatment of hypertension. Moving beyond office blood pressure to achieve a personalized and more precise hypertension management.
        Which way to go? Hypertension. 2017; 70: e20-e31
        • Stergiou G.S.
        • Palatini P.
        • Asmar R.
        • et al.
        Blood pressure monitoring: theory and practice. European Society of Hypertension working group on blood pressure monitoring and cardiovascular variability teaching course proceedings.
        Blood Press Monit. 2018; 23: 1-8
        • Shimbo D.
        • Abdalla M.
        • Falzon L.
        • et al.
        Studies comparing ambulatory blood pressure and home blood pressure on cardiovascular disease and mortality outcomes: a systematic review.
        J Am Soc Hypertens. 2016; 10: 224-234
        • Burke L.E.
        • Ma J.
        • Azar K.M.
        • et al.
        Current science on consumer use of mobile health for cardiovascular disease prevention: a scientific statement from the American Heart Association.
        Circulation. 2015; 132: 1157-1213
        • Kim Y.N.
        • Shin D.G.
        • Park S.
        • et al.
        Randomized clinical trial to assess the effectiveness of remote patient monitoring and physician care in reducing office blood pressure.
        Hypertens Res. 2015; 38: 491-497
        • Milani R.V.
        • Lavie C.J.
        • Bober R.M.
        • et al.
        Improving hypertension control and patient engagement using digital tools.
        Am J Med. 2017; 130: 14-20


      Bridget Shoulders, MSN, ACNP-BC, works as a cardiology nurse practitioner in the Cardiology Department, James A. Haley VA Hospital, Tampa, Florida. She is available at .


      Laurie Powell, MSN, AGNP-BC, is a nurse in the Electrophysiology Section, James A. Haley VA Hospital, Tampa, Florida.