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Management of raised blood pressure in New Zealand: a discussion document
Insights
New Zealand guidelines recommend treating high blood pressure based on cardiovascular disease risk, not just blood pressure readings. Treatment is advised for those with over 20% 10-year risk, potentially shifting focus to older individuals.
Area of Science:
- Cardiology
- Public Health Policy
- Pharmacology
Background:
- Raised blood pressure (hypertension) is a significant risk factor for cardiovascular disease (CVD).
- Current treatment decisions for hypertension are being re-evaluated for optimal patient outcomes.
- New Zealand's National Advisory Committee on Core Health and Disability Support Services reviewed hypertension management.
Purpose of the Study:
- To recommend a shift in hypertension management strategies in New Zealand.
- To define criteria for initiating blood pressure-lowering treatment based on absolute CVD risk.
- To guide first-line pharmacological interventions for hypertension.
Main Methods:
- Analysis of clinical trial data on the efficacy of blood pressure treatment.
- Risk stratification models for estimating 10-year cardiovascular disease event probability.
- Review of evidence for specific drug classes in reducing stroke and coronary heart disease.
Main Results:
- Treatment decisions for raised blood pressure should prioritize estimated absolute CVD risk over isolated blood pressure values.
- Patients with systolic blood pressure 150-170 mm Hg or diastolic 90-100 mm Hg, and a >20% 10-year CVD risk, are candidates for treatment.
- Approximately 150 individuals require treatment to prevent one annual cardiovascular event at this risk threshold.
Conclusions:
- Implementing risk-based treatment may lead to fewer younger individuals, especially women, being treated, while increasing treatment for older populations.
- Low-dose diuretics and beta-blockers are recommended as first-line treatments due to evidence of reduced stroke and coronary disease risk.
- This approach aims to optimize resource allocation and improve cardiovascular health outcomes through targeted hypertension management.
Abstract:
A report to the National Advisory Committee on Core Health and Disability Support Services, New Zealand, on the management of raised blood pressure recommends that decisions to treat raised blood pressure should be based primarily on the estimated absolute risk of cardiovascular disease rather than on blood pressure alone. In general, patients with a blood pressure of 150-170 mm Hg systolic or 90-100 mm Hg diastolic, or both, should be given treatment to lower blood pressure if the risk of a major cardiovascular disease event in 10 years is more than about 20%. The results of clinical trials indicate that, at this level of absolute risk, 150 people would require treatment to reduce the annual number of cardiovascular events by about one. Implementation of these recommendations may result in a smaller proportion of people aged under 60, particularly women, receiving treatment but an increased proportion of older people treated. In the absence of specific contraindications, low dose diuretics and low dose beta blockers should be considered for first line treatment, since for only these drug groups is there direct evidence of reduced risk of stroke and coronary disease in people with raised blood pressure.