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Management guidelines for hypertension: is anyone taking notice?
1Department of Medicine, University of Leicester, Leicester Royal Infirmary, UK.
Insights
Accurate blood pressure (BP) measurement is key for hypertension management. Guidelines recommend non-drug treatments first, with drug therapy thresholds varying, especially for patients with multiple risk factors.
Area of Science:
- Cardiology
- Public Health
Background:
- Multiple national bodies and the World Health Organisation/International Society of Hypertension offer hypertension treatment guidelines.
- There is general consensus among these guidelines regarding hypertension management.
- Accurate blood pressure (BP) measurement is fundamental for clinical hypertension management.
Purpose of the Study:
- To outline current guidelines for hypertension treatment.
- To highlight consensus and controversies in hypertension management thresholds and goals.
- To emphasize the importance of effective hypertension management for reducing cardiovascular mortality.
Main Methods:
- Review of published guidelines from national bodies and international organizations (WHO/ISH).
- Analysis of recommended thresholds for initiating drug therapy based on BP levels.
- Evaluation of evidence regarding treatment benefits, particularly in elderly patients.
Main Results:
- Consensus exists on the importance of accurate BP measurement and non-pharmacological interventions for mild-to-moderate hypertension.
- Diastolic BP thresholds for drug initiation range from 90-100 mmHg, and systolic thresholds from 140-160 mmHg.
- Thresholds are lower (140/90 mmHg) with co-existing risk factors. The goal is typically DBP < 90 mmHg, with debate on < 80 mmHg.
Conclusions:
- Elderly patients show significant benefit from hypertension treatment.
- Inadequately controlled BP in treated patients leads to high risk of premature cardiovascular death.
- There is a need for practical, routine-use clinical guidelines for hypertension management.
Abstract:
A number of national bodies and the World Health Organisation/International Society of Hypertension have published guidelines on the treatment of hypertension, and there is reasonable consensus between them. Repeated and accurate BP measurements are an essential starting point in the clinical management of hypertension. In mild-to-moderate hypertension, non-pharmacological treatments should always be instituted and their impact evaluated before drugs are considered. The recommended diastolic threshold for initiation of drug therapy varies between 90 and 100 mmHg and the systolic threshold lies between 140 and 160 mmHg. There is also agreement that this threshold should be reduced to 140/90 mmHg when multiple risk factors co-exist. The generally accepted aim of treatment is to reduce DBP to < 90 mmHg, but there is controversy about lowering it further to < 80 mmHg. There is convincing evidence that elderly patients benefit most from treatment. It is also clear that treated patients with inadequately controlled BP remain at high risk of premature cardiovascular death. This highlights the need for guidelines that are suitable for routine use in clinical practice.