Reduction in the level of blood pressure (BP) from 140/90 to 130/80 mm Hg for defining hypertension is one of the major practice changing modifications of the 2017 American College of Cardiology/American Heart Association guidelines which are bound to have a huge societal impact. The number of hypertension patients will increase 1.5 times after this definition change. Although the BP levels for defining hypertension have changed, the levels at which pharmacological therapy should be started have remained the same, i.e., ≥140/90 mm Hg (Stage 2 hypertension according to newer guidelines) except in special situations (clinical atherosclerotic cardiovascular disease or estimated 10-year cardiovascular disease risk of ≥10%). All in all, definitely these guidelines are more comprehensive, give a much more clarity to the treating physician, and are aimed at better long-term prevention of target-organ damage. But at the same time, they leave us in the same dilemma which arises after every major guideline change: how to deal with patients who are being treated as per the old guidelines?
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