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The Management of Hypertension in 2018: What Should the Targets Be?
1Department of Medicine, AHA Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, University of Chicago Medicine, Chicago, IL, USA.
Insights
Global hypertension management guidelines differ, with the US defining hypertension at a lower threshold (130/80 mmHg) than other regions (140/90 mmHg). All guidelines stress lifestyle changes, risk assessment, and combination therapy for blood pressure control.
Area of Science:
- Cardiology
- Public Health
- Internal Medicine
Background:
- Hypertension management guidelines vary globally, impacting patient care and treatment strategies.
- Understanding these differences is crucial for effective blood pressure control worldwide.
Purpose of the Study:
- To provide a comparative overview of international hypertension management guidelines.
- To highlight key similarities and differences in diagnostic criteria and therapeutic approaches.
Main Methods:
- Review of current hypertension management guidelines from the US, Europe, Canada, and Latin America.
- Comparative analysis of diagnostic thresholds, treatment initiation, and therapeutic recommendations.
Main Results:
- A significant divergence exists in the definition of hypertension, with the US adopting a lower threshold (≥130/80 mmHg) compared to other regions (≥140/90 mmHg).
- Most guidelines prioritize lifestyle modifications for initial therapy, particularly for blood pressure levels below 140/90 mmHg, with the US emphasizing it at all levels.
- All guidelines underscore the importance of cardiovascular risk assessment, proper blood pressure measurement techniques, home monitoring, and combination therapy, with some recommending initial combination pills.
Conclusions:
- The primary distinction in global hypertension guidelines lies in the definition of the condition.
- Despite definitional differences, consensus exists on the importance of lifestyle modifications, risk stratification, accurate measurement, and combination therapy for managing hypertension effectively.
Purpose Of Review:
To provide an overview of the different guidelines for hypertension management from around the world.
Recent Findings:
The guidelines discussed include those from the United States (US), Europe, Canada, and Latin America. All guidelines except the US define hypertension as > 140/90 mmHg, and the US defines it as > 130/80 mmHg. In general, all guidelines except those from the US emphasize lifestyle modification as the cornerstone of initial therapy given blood pressure levels < 140/90 mmHg. The US emphasizes lifestyle modification at all BP levels starting at 130/80 mmHg. Additionally, all guidelines emphasize the need to assess cardiovascular risk with the Canadian guidelines indicating that a high cardiovascular risk person should have a goal of < 130/80 mmHg. All agree on the proper method of blood pressure measurement techniques and importance of home blood pressure. All support use combination therapy with the European guideline emphasizing initial therapy should be a combination pill. All guidelines stress the importance of patient adherence to maintain blood pressure control. All guidelines emphasize lifestyle modification, need for home blood pressure measurement, as well as use of proper techniques to measure blood pressure. The fundamental difference between US and all other guidelines is the definition of hypertension, > 130/80 mmHg in US and > 140/90 mmHg in the rest of the world.
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