Elevated blood pressure in the US accounts for more deaths from atherosclerotic cardiovascular disease (ASCVD) than any other modifiable ASCVD risk factor (eg, lipids, obesity, diabetes). Among US adults the prevalence of hypertension (defined as ≥130/≥80 mm Hg) is 46%.
The 2019 American Heart Association and American College of Cardiology Guideline on the Primary Prevention of Cardiovascular Disease provides hypertension management recommendations based on the most recent evidence available. Primary care is where ASCVD prevention begins.
The 5 questions that follow test what you know about guideline-recommended hypertension goals and disease management.
1. In the Johns Hopkins ABCDEFG approach to cardiovascular disease prevention, what does the letter F stand for?
Answer: D. Factors of the environment. The Johns Hopkins ABCDEFG approach focuses on optimizing cardiovascular disease risk through multidisciplinary approaches using lifestyle, behavioral, pharmacologic, and other interventions.
Johns Hopkins ABCDEFG Mnemonic for CVD prevention.
2. For which of the following patients above the ACC/AHA recommend antihypertensive medication?
Answer: Both A and C. The ACC/AHA recommends BP-lowering medication, along with lifestyle interventions, in the two scenarios above. An ASCVD risk calculator is available here.
3. Among patients with established hypertension, which of the above is associated with the largest decrease in systolic blood pressure?
Answer: D. DASH Diet. For weight loss, a 1 mmHg decrease in systolic blood pressure can be expected for each 1 kg decrease in body weight. The DASH diet is high in fruits, vegetables, whole grains and lowfat dairy, and low in saturated and total fat.
4. According to ACC/AHA guidelines, in patients with chronic kidney disease (CKD) and hypertension blood pressure should be treated to a goal of which of the above?
Answer: B. 130/80 mmHg. Most patients with CKD have a 10y ASCVD risk ≥10% and require antihypertensive medication. For these patients, the ACC/AHA guidelines recommend a treated blood pressure goal of 130/80 mmHg.
SPRINT trial.
5. True or False: The ACC/AHA recommends low-dose aspirin for primary prevention of ASCVD among all adults aged 40 to 70 years.
Answer: B. False. Prophylactic use of aspirin is no longer universally recommended for ASCVD prevention; this revised guidance is based on evidence from recent primary prevention trials that suggest the overall benefits of aspirin may not outweigh bleeding risk.
Low-dose aspirin should not be used for primary prevention of ASCVD among adults over age 70 years, nor among individuals of any age who are at increased risk for bleeding.
