Bp guidelines
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Blood Pressure Management Guidelines: A Comprehensive Overview
Blood Pressure Management in Acute Stroke
Acute Ischaemic Stroke (AIS) and Intracerebral Haemorrhage (ICH)
The European Stroke Organisation (ESO) guidelines provide evidence-based recommendations for blood pressure (BP) management in acute ischaemic stroke (AIS) and intracerebral haemorrhage (ICH). For AIS patients undergoing reperfusion therapies, early and modest BP control is recommended, specifically avoiding levels above 180/105 mm Hg. This approach is based on the low quality of evidence from several large randomized-controlled trials, which showed inconsistent results regarding the benefits of BP lowering in AIS. In contrast, for acute ICH, there is stronger evidence supporting intensive BP lowering immediately after hospital presentation to reduce haematoma expansion and improve recovery.
Blood Pressure Targets in Diabetes and Impaired Glucose Tolerance
Type 2 Diabetes Mellitus and Impaired Fasting Glucose
Most guidelines recommend a BP goal of less than 140/90 mm Hg for hypertensive patients, with a more aggressive target of less than 130/80 mm Hg for those with diabetes mellitus. However, the ACCORD trial found that lower BP targets did not provide additional benefits. A meta-analysis of 13 randomized clinical trials involving 37,736 participants indicated that intensive BP control (≤135 mm Hg) reduced all-cause mortality by 10% and stroke by 17%, but increased serious adverse effects by 20%. The optimal systolic BP target for patients with type 2 diabetes or impaired glucose tolerance appears to be between 130 and 135 mm Hg, as more aggressive targets did not show additional benefits for other macrovascular or microvascular events and increased the risk of serious adverse events.
General Hypertension Management in Adults
Recommendations from Professional Organizations
The American College of Cardiology (ACC) and the American Heart Association (AHA) have developed comprehensive guidelines for hypertension management. These guidelines recommend a BP target of less than 130/80 mm Hg for patients with confirmed hypertension and cardiovascular disease (CVD) or a 10-year atherosclerotic CVD risk of 10% or higher. For patients with chronic kidney disease or diabetes mellitus, the same target is recommended. First-line antihypertensive drugs include thiazide diuretics, calcium-channel blockers (CCBs), angiotensin-converting enzyme inhibitors (ACE-Is), or angiotensin-receptor blockers (ARBs).
Hypertension Management in Older Adults
Specific Targets for Adults Aged 60 and Older
The American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) recommend that clinicians choose BP treatment goals for adults aged 60 and older based on individual cardiovascular history and risk levels. For most older adults, a systolic BP target of less than 150 mm Hg is recommended, with a more aggressive target of less than 140 mm Hg for those with a history of stroke, transient ischemic attack, or high cardiovascular risk . These recommendations are based on moderate to high-quality evidence showing reductions in all-cause mortality, stroke, and cardiac events with these targets .
Pediatric Hypertension
Updated Guidelines for Children and Adolescents
The updated pediatric hypertension guidelines replace the term "prehypertension" with "elevated blood pressure" and provide new normative BP tables based on normal-weight children. The guidelines recommend BP screening only during preventive care visits and emphasize the use of ambulatory BP monitoring for diagnosis and management. Hypertension in children is defined as BP values of 135/80 mm Hg or higher, with specific recommendations for initial evaluation and management.
Home Blood Pressure Monitoring
Japanese Society of Hypertension (JSH) Guidelines
The JSH guidelines emphasize the importance of home BP measurements for managing hypertension. They recommend using validated arm-cuff devices and measuring BP in the morning and evening under specific conditions. Home BP values of 135/80 mm Hg or higher indicate hypertension, and these measurements are considered crucial for clinical decision-making.
Conclusion
Blood pressure management guidelines vary based on patient demographics and specific health conditions. For acute stroke, early and modest BP control is recommended for AIS, while intensive BP lowering is advised for ICH. In patients with diabetes, a systolic BP target of 130 to 135 mm Hg is optimal. General guidelines recommend a target of less than 130/80 mm Hg for high-risk adults, while older adults should aim for less than 150 mm Hg, with more aggressive targets for those with higher cardiovascular risk. Pediatric guidelines focus on updated BP classifications and the use of ambulatory monitoring, while home BP monitoring is emphasized for accurate hypertension management. These guidelines aim to optimize BP control and improve patient outcomes across various populations.
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