Lakhasly

tion, and Treatment of High Blood Pressure.4 The 2017 guidelines removed the classification of “prehypertension,” added diagnoses of “elevated blood pressure” for systolic blood pressure (SBP)=120 to 129 mmHg with diastolic blood pressure (DBP) <80 mmHg, and reduced the threshold for diagnosing stage I hypertension to SBP=130 to 139 mm Hg or DBP=80 to 89 mm Hg. The treatment recommendation for elevated blood pressure and stage I hypertension, with Atherosclerotic Cardiovascular Dis- ease (ASCVD) risk score <10%, is nonpharmacological, lifestyle-only treatment (see Figure A). An estimated 21% of US adults (≈53 million) meet the 2017 guidelines cri- teria for lifestyle-only treatment, including 12% of adults with elevated blood pressure and 9% who are diagnosed with stage I hypertension but have an ASCVD risk score of <10% (see Figure A, light gray box).5 The 2018 AHA/ACC Guideline on the Management of Blood Cholesterol3 updated the 2013 guidelines.6 This update continues to advocate lifestyle-only approaches for adults 40 to 75 years of age with low-density lipopro- tein cholesterol (LDL-C) >70 mg/dL and low ASCVD risk scores (<7.5%). The update also clarifies that for similarly aged adults with LDL-C >70 mg/dL, intermediate ASCVD risk scores (7.5%–20%), low coronary artery calcium score (<100 Agatston units), and a low burden of other risk fac- tors (eg, LDL-C <160 mg/dL; free from metabolic syndrome, chronic kidney disease, inflammatory diseases, etc), lifestyle- only treatment is an option during the clinician/patient shared decision-making management approach.9 Although an exact figure is not available, we conservatively estimate that ≈28% of US adults (≈71 million) would meet the 2018 Cholesterol Clinical Practice Guideline criteria for lifestyle-only treatment using current US Census data and a report of statin eligibil- ity based on the 2013 cholesterol guidelines.7,8 This approx- imation includes adults 40 to 75 years of age with LDL-C >70 mg/dL and ASCVD risk score <7.5% (see Figure B). This estimate is conservative because it does not include the 9% of US adults (≈23 million) 40 to 75 years of age with LDL-C >70 g/dL but intermediate ASCVD risk scores. These

tion, and Treatment of High Blood Pressure.4 The 2017 guidelines removed the classification of “prehypertension,” added diagnoses of “elevated blood pressure” for systolic blood pressure (SBP)=120 to 129 mmHg with diastolic blood pressure (DBP)