“ The ACC / AHA now strongly
recommends ambulatory blood pressure monitoring , which can occur outside of the clinic if patients are supported with the appropriate tools , and tailoring the antihypertensive regimen to a patient ’ s comorbid conditions .”
While these new guidelines will lead to an increase in the number of stage one and two diagnoses , the change makes logical sense from a patient safety perspective . As hypertension exacerbates , it becomes more challenging to control . Thus , lowering the threshold for hypertension compels physicians to intervene earlier , ultimately slowing progression and resulting in fewer adverse events .
By lowering ranges , lifestyle interventions such as weight loss and adoption of a healthier nutrient intake can begin earlier in treatment plans . Not only does this help to eliminate the progression of hypertension , once diagnosed , it also facilitates increased patient engagement much sooner .
The decision to establish more lenient blood pressure thresholds was made in response to adverse patient events following aggressive treatment protocols — patients passing out from too much medication , for example . The commission failed to account for patients who benefit from higher blood pressures at rest , such as those who become hypotensive on dialysis or those with autonomic dysfunction that causes orthostatic hypotension upon standing . Further , JNC-8 assumed that hypertension exists on its own , thereby failing to recognize comorbid conditions that often more accurately direct anti-hypertensive treatment .
The recommendations also assumed that blood pressure monitoring could only be completed in the clinic , which left patients unmonitored and without critical support between clinic visits . Conversely , the ACC / AHA now strongly recommends ambulatory blood pressure monitoring , which can occur outside of the clinic if patients are supported with the appropriate tools , and tailoring the anti-hypertensive regimen to a patient ’ s comorbid conditions . While this is more complicated than the JNC-8 recommendations , the ACC / AHA guidelines are more appropriate , more accurate , and easily achievable with implementation of new technologies .
Leveraging technology to monitor blood pressure
The ACC / AHA recommends that patients with severe hypertension
receive timely evaluation and drug treatment supported by patient monitoring and dose adjustments . Although it ’ s possible to remotely monitor hypertension and hypertension-related disorders , this process would require a tool that enables self-monitoring of blood pressure multiple times throughout the day . By allowing patients to selfmonitor , they can effectively associate their symptoms or lack thereof with their blood pressure .
Telemedicine solutions offer promise in helping hypertensive patients record their blood pressure appropriately . Easily-understandable reminders can ensure that patients take the appropriate dose of medications at the prescribed time . As patients record data , providers must have the ability to aggregate and analyze the data and make titrations as needed . Small frequent titrations in blood pressure medications will allow for patients to rapidly reach treatment goals and prevent the occurrence of adverse events .
By centralizing communications , hypertension specialists can choose an optimal anti-hypertensive regimen for each patient based on their existing comorbid conditions . For example , a provider may prescribe beta blockers and ace-inhibitors for a patient with systolic heart failure , while avoiding
“ The ACC / AHA now strongly
recommends ambulatory blood pressure monitoring , which can occur outside of the clinic if patients are supported with the appropriate tools , and tailoring the antihypertensive regimen to a patient ’ s comorbid conditions .”
Dustyn Williams , MD
beta-blockers as front-line agents and ace-inhibitors altogether for a patient with chronic kidney disease stage IV .
These solutions will also allow for individualization to occur in treatment . For instance , a telemedicine application can remind dialysis patients of the altered medication treatment plan on the days they receive treatment for their condition . If platforms adopt predefined hypertension regimens based on comorbid conditions , then provider organizations can achieve facility-wide standardization in hypertension treatments . Further , titration capabilities along with ambulatory blood pressure monitoring can provide patients with a sophisticated reorganization of blood pressure medications throughout the day , optimizing blood pressure rates and reducing adverse events , while allowing patients to manage their condition from the comfort of their own home .
As the ACC / AHA hypertensive guidelines align with the shift towards quality , health care organizations participating in quality programs may require more stringent blood pressure goals . To achieve these goals and ensure patient safety , it is essential that technology is leveraged to allow for tight control , real-time feedback and medication adjustments between clinic visits .
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