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Modern strategies to prevent coronary sequelae and stroke in hypertensive patients differ from the JNC V Consensus
L Tobian1, H R Brunner, J N Cohn
1American Society of Hypertension, New York, NY.
Insights
Official hypertension guidelines often conflict with expert opinions. Most experts prefer alternative first-line treatments over diuretics and beta-blockers to prevent cardiovascular events and improve long-term quality of life.
Area of Science:
- Cardiology
- Clinical Practice Guidelines
- Hypertension Management
Background:
- Government agencies establish consensus guidelines for hypertension evaluation and treatment.
- These guidelines are often perceived as directives by healthcare providers.
- Official guidelines may not align with the practices of hypertension experts.
Purpose of the Study:
- To summarize the opinions of seven hypertension experts on the impact of official guidelines.
- To present individual therapeutic recommendations from these experts.
- To highlight the diversity in expert-recommended treatment strategies for essential hypertension.
Main Methods:
- Summarized opinions of seven hypertension experts.
- Detailed individual therapeutic recommendations of the panel members.
- Compared expert recommendations against established U.S. hypertension guidelines.
Main Results:
- None of the seven experts' treatment strategies followed U.S. guideline preferences for first-line therapy (diuretics and beta-blockers).
- Experts prioritized preventing cardiovascular sequelae (heart attack, stroke, heart failure) over solely reducing blood pressure.
- Experts favored individualized treatment regimens, diverging from rigid guideline recommendations.
Conclusions:
- Official hypertension guidelines may lack the flexibility needed for optimal individualized patient care.
- Healthcare providers should not feel compelled to strictly adhere to official guideline preferences.
- Expert consensus suggests prioritizing long-term quality of life and cardiovascular event prevention in hypertension management.
Abstract:
In recent years, government agencies of many countries have established consensus guidelines for the evaluation and treatment of hypertension. Once published, guidelines tend to be perceived as directives by a variety of health care providers. Unfortunately, these guidelines often do not reflect the practices of most hypertension experts. This report summarizes the opinions of seven hypertension experts concerning the impact of "official" guidelines on clinical practice. In addition, the individual therapeutic recommendations of these panel members are summarized. Their different treatment strategies reflect the diversity of first rate treatment plans that aim to reduce the cardiovascular sequelae in individual patients with essential hypertension. Most importantly, not one of these seven treatment strategies followed the "preferred" treatment of the U.S. guidelines, which recommend diuretics and beta-blockers as first-line therapy. The present authors approach the treatment of hypertension as a means to reduce cardiovascular events. Thus, reduction of blood pressure is not the most important therapeutic endpoint. The panel believes that whereas many different drugs can produce effective blood pressure reduction, the modern primary goal of antihypertensive drug therapy is to select a regimen most likely to prolong the quality and duration of life. In real terms, this means that the primary goal of treatment is the prevention of the major vascular sequelae of hypertension (heart attack, ventricular remodeling, hypertrophy, heart failure, and stroke) that shorten useful life. There are a number of effective hypertensive treatments, which can be selected based on individual patient requirements. However, many consensus guidelines do not allow the flexibility required to optimize individual patient treatment. As a result, health care providers should not feel compelled to regard the preferences of "official" guidelines as the best, modern, state-of-the-art therapy for an individual patient. All seven experts who are deeply involved in the daily care of patients preferred drugs other than beta-blockers and diuretics (the Joint National Committee [JNC] choices) for first-line therapy of hypertension.