From the Guidelines
The latest guidelines for hypertension recommend a blood pressure target of less than 130/80 mmHg for most adults, as stated by the American College of Cardiology and the American Heart Association in 2017 1.
Key Recommendations
- The guidelines emphasize the importance of early intervention and lifestyle modifications to manage high blood pressure.
- A more individualized approach to treatment is recommended, taking into account factors such as age, comorbidities, and medication side effects.
- The guidelines suggest that adults aged 60 years or older with systolic blood pressure persistently at or above 150 mmHg should be treated to achieve a target systolic blood pressure of less than 150 mmHg to reduce the risk for mortality, stroke, and cardiac events 1.
- For adults with a history of stroke or transient ischemic attack, the guidelines recommend treating to a target systolic blood pressure of less than 140 mmHg to reduce the risk for recurrent stroke 1.
Medication Considerations
- The guidelines discuss the use of various antihypertensive medications, including thiazide-type diuretics, ACEIs, ARBs, calcium-channel blockers, and β-blockers, and their potential side effects 1.
- The choice of medication should be based on individual patient characteristics, such as comorbidities and medication side effects.
Comparison with Other Guidelines
- The American College of Cardiology/American Heart Association (ACC/AHA) guidelines differ from the European Society of Cardiology (ESC)/European Society of Hypertension (ESH) guidelines in terms of the definition of hypertension and the recommended blood pressure targets 1.
- The ESC/ESH guidelines recommend a blood pressure target of less than 140/90 mmHg for most adults, while the ACC/AHA guidelines recommend a target of less than 130/80 mmHg.
From the Research
Latest Guidelines for Hypertension
The latest guidelines for hypertension have been published by various organizations, including the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) 2, 3. These guidelines provide recommendations for the diagnosis, treatment, and management of hypertension.
Diagnosis and Treatment
The ESC guidelines introduce a new category of "elevated blood pressure" (120-139/70-89 mm Hg) and recommend lifestyle modifications for all patients with elevated blood pressure 3. The guidelines also recommend initiating lifestyle modifications and antihypertensive medication concurrently for patients with hypertension (≥ 140/90 mm Hg). The target systolic blood pressure is 120-129 mm Hg, with individualized treatment goals for patients with frailty or age ≥85 years.
Key Recommendations
- Implement lifestyle modifications for all patients with elevated blood pressure 3
- Initiate lifestyle modifications and antihypertensive medication concurrently for patients with hypertension (≥ 140/90 mm Hg) 3
- Target systolic blood pressure is 120-129 mm Hg, with individualized treatment goals for patients with frailty or age ≥85 years 3
- Use spironolactone for resistant hypertension, with renal denervation as an alternative option to increasing antihypertensive medication 3
Outpatient Management
The outpatient management of essential hypertension involves a comprehensive approach, including non-pharmacological and pharmacological interventions 4. The American clinical guidelines recommend individualized treatment plans tailored to patients' specific risk profiles and comorbidities.
Standardized Treatment Protocols
Standardized treatment protocols (STPs) for hypertension are available globally, but most of them have scope for improvement through interventions aimed at alignment with the latest evidence-based guidelines and multistakeholder engagement 5. The STPs should be critically appraised using checklists such as the HEARTS in the Americas Checklist for hypertension management in primary care.