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The Evolution of Hypertension Guidelines Over the Last 20+ Years: A Comprehensive Review

Endurance O Evbayekha1, Okelue E Okobi2,3, Tobechukwu Okobi4

  • 1Internal Medicine, St. Luke's Hospital, Chesterfield, USA.

Cureus
|December 16, 2022
PubMed

Insights

Hypertension guidelines have evolved significantly over 22 years, focusing on at-risk groups and personalized treatment based on disease stage and comorbidities, not ethnicity.

Area of Science:

  • Cardiology
  • Nephrology
  • Neurology

Background:

  • Hypertension is a primary modifiable risk factor for cardiovascular and cerebrovascular diseases.
  • Guideline recommendations for hypertension management have undergone substantial evolution over the past two decades.
  • This evolution reflects advancements in understanding and treating hypertension in diverse patient populations.

Purpose of the Study:

  • To systematically review the literature on hypertension management guidelines published between 2000 and 2022.
  • To identify key changes and trends in hypertension screening and treatment recommendations over a 22-year period.
  • To analyze the factors influencing guideline evolution, particularly for specific patient subgroups.

Main Methods:

  • A comprehensive literature search was conducted across PubMed, Embase, Google Scholar, and Cochrane databases.
  • Keywords "hypertension" and "guidelines" were used with Boolean operators for article retrieval.
  • Systematic screening of titles, abstracts, and full-text articles was performed to identify eligible publications, with 190 articles meeting inclusion criteria.

Main Results:

  • Guideline evolution primarily focused on refining management thresholds for elderly patients and those with diabetic kidney disease, chronic kidney disease, and stroke.
  • Current medication choices are increasingly guided by disease stage and comorbidities, shifting away from ethnicity-based criteria.
  • Significant changes in hypertension management strategies have been observed over the 22-year study period.

Conclusions:

  • Hypertension management guidelines have become more nuanced, incorporating patient-specific factors for improved care.
  • The shift towards personalized medicine in hypertension treatment reflects a deeper understanding of the disease and its impact on various populations.
  • Continued evaluation of guidelines is essential to adapt to new evidence and optimize patient outcomes.

Keywords:
cardiovascular diseaseguidelinesheart healthhypertensionhypertensive heart diseasereview

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