From the Research
For adult Filipinos, the recommended blood pressure threshold for treatment and target for cardiovascular disease prevention is less than 130/80 mmHg for most adults with hypertension, as stated in the 2020 Philippine Clinical Practice Guidelines of hypertension 1. This target is based on evidence that maintaining blood pressure below this level significantly reduces the risk of cardiovascular events such as heart attacks and strokes. However, for elderly patients over 80 years of age with hypertension, a less stringent goal of less than 150/90 mmHg is recommended to balance cardiovascular protection with the risks of adverse effects from more aggressive treatment. Some key points to consider in the management of hypertension in adult Filipinos include:
- Lifestyle modifications such as reduced sodium intake, regular physical activity, weight management, and limited alcohol consumption should be the initial approach to managing hypertension.
- If lifestyle modifications are insufficient, medication options include thiazide diuretics, calcium channel blockers, ACE inhibitors, or ARBs as first-line agents, with dosages titrated gradually to reach target blood pressure while minimizing side effects, as suggested by recent studies comparing ACE inhibitors and ARBs 2, 3, 4.
- Regular monitoring is essential to ensure blood pressure targets are maintained and to adjust treatment as needed.
- The choice between ACE inhibitors and ARBs should be based on individual patient characteristics, such as the presence of comorbidities and potential side effects, with recent evidence suggesting that ARBs may have improved tolerability compared to ACE inhibitors 2, 4. It is also important to consider the potential benefits and risks of different treatment strategies, including the risk of bradykinin-mediated side effects like angioedema and cough associated with ACE inhibitors, and the potential neuroprotective effects of ARBs 4. Overall, the management of hypertension in adult Filipinos should be guided by the principles of evidence-based medicine, with a focus on individualized treatment and regular monitoring to optimize outcomes and minimize adverse effects.