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Hypertension clinical guideline 2000
Insights
Treating hypertension effectively lowers stroke and heart failure risks. Target blood pressure (BP) is systolic < 140 mmHg and diastolic < 90 mmHg, with gradual reduction for elderly and severe cases.
Area of Science:
- Cardiology
- Hypertension Management
Background:
- Extensive data from randomized controlled trials confirm the benefits of hypertension treatment.
- Optimal blood pressure (BP) targets are systolic < 140 mmHg and diastolic < 90 mmHg, aiming for minimal side effects.
Framework:
- Cardiovascular risk factors must be evaluated to inform antihypertensive therapy.
- Lifestyle modifications and patient education are crucial components of management.
- Specific guidelines address situations like hypertensive emergencies and hypertension in diabetes mellitus.
Implementation:
- First-line treatment involves low-dose diuretics.
- Second-line options include reserpine, beta-blockers, ACE inhibitors, or calcium channel blockers.
- Third-line therapy may involve adding another second-line agent, hydralazine, or an alpha-blocker.
Implications:
- Effective BP control reduces the risk of stroke, cardiac failure, renal insufficiency, and coronary artery disease.
- Gradual BP reduction over 6 months is recommended for the elderly and those with severe hypertension.
- Stricter BP control is necessary for patients with end-organ damage, risk factors, or comorbidities like diabetes.
Outcomes:
Extensive data from many randomised controlled trials have shown the benefit of treating hypertension. The target blood pressure (BP) for antihypertensive management should be systolic < 140 mmHg and diastolic < 90 mmHg, with minimal or no drug side-effects. However, a lesser reduction will elicit benefit, although this is not optimal. The reduction of BP in the elderly and in those with severe hypertension should be achieved gradually over 6 months. Stricter BP control is required for patients with end-organ damage, coexisting risk factors and co-morbidity, e.g. diabetes mellitus. Coexistent risk factors should also be controlled.
Benefits:
Reduction in risk of stroke, cardiac failure, renal insufficiency and probably coronary artery disease. The major precautions and contraindications to each antihypertensive drug recommended are listed.
Recommendations:
Correct BP measurement procedure is described. Evaluation of cardiovascular risk factors and recommendations for antihypertensive therapy are stipulated. The total cardiovascular disease risk profile should be determined for all patients and this should inform management strategies. Lifestyle modification and patient education play an essential role in the management strategy.
Drug Therapy:
First line--low-dose diuretics; second line--add one of the following: reserpine, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors or calcium channel blockers; third line--add another second-line drug or hydralazine or an alpha-blocker. The guideline includes management of specific situations, e.g. hypertensive emergency or urgency, severe hypertension with target organ damage and refractory hypertension (BP > 160/95 mmHg on triple therapy), hypertension in diabetes mellitus, etc.
Validation:
The guideline was developed by the Executive Committee of the Southern African Hypertension Society with consensus meeting endorsement, and is endorsed by the South African Medical Association Guideline Commitee.