Hypertension guidelines
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Hypertension Guidelines: A Comprehensive Overview
Classification and Diagnosis of Hypertension
The classification of blood pressure (BP) and the diagnosis of hypertension have evolved significantly over the years. According to the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines, normal BP is defined as an average systolic BP (SBP) of less than 120 mm Hg and an average diastolic BP (DBP) of less than 80 mm Hg. The term "prehypertension" has been replaced with "elevated BP" (SBP of 120-129 mm Hg and DBP less than 80 mm Hg) and "stage 1 hypertension" (SBP of 130-139 mm Hg or DBP of 80-89 mm Hg). Stage 2 hypertension is now defined as an SBP of at least 140 mm Hg or a DBP of at least 90 mm Hg.
Blood Pressure Measurement Techniques
Accurate BP measurement is crucial for the diagnosis and management of hypertension. The ACC/AHA guidelines emphasize the importance of obtaining accurate measurements, recommending that clinicians base their estimates on an average of at least two readings obtained on at least two separate occasions. The use of out-of-office BP measurements, such as ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM), is encouraged to confirm the diagnosis and manage treatment .
Risk Assessment and Secondary Hypertension
Assessing global cardiovascular risk is essential in managing hypertension. The presence of cardiovascular risk factors and target organ damage should be evaluated to determine the urgency and intensity of treatment . Screening for secondary causes of hypertension is recommended in specific circumstances, such as resistant hypertension or the presence of clinical clues suggesting a secondary cause.
Nonpharmacologic Interventions
Lifestyle modifications are a cornerstone in the management of hypertension. Recommended interventions include adopting the Dietary Approaches to Stop Hypertension (DASH) diet, reducing dietary sodium intake, increasing physical activity, and limiting alcohol consumption. These changes are particularly emphasized for individuals newly classified with stage 1 hypertension (SBP 130-139 mm Hg or DBP 80-89 mm Hg).
Pharmacologic Treatment and BP Targets
Pharmacologic treatment is recommended for individuals with stage 1 hypertension who have a history of cardiovascular disease (CVD) or are at high risk for CVD. The ACC/AHA guidelines suggest initiating treatment with two antihypertensive drugs for patients with BP more than 20/10 mm Hg above the target . The target BP for most patients is less than 130/80 mm Hg, with specific considerations for older adults and those with comorbid conditions .
Special Populations: Older Adults and Comorbid Conditions
The management of hypertension in older adults and those with comorbid conditions requires careful consideration. For adults aged 60 years or older, the American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) recommend a target SBP of less than 150 mm Hg, with a lower target of 140 mm Hg for those with a history of stroke or transient ischemic attack. The presence of comorbid conditions, such as diabetes or chronic kidney disease, may necessitate more aggressive BP targets and tailored treatment strategies .
Conclusion
The management of hypertension involves a comprehensive approach that includes accurate BP measurement, risk assessment, lifestyle modifications, and pharmacologic treatment. The guidelines provided by various organizations, including the ACC/AHA, ACP, AAFP, and Hypertension Canada, offer evidence-based recommendations to optimize the diagnosis, prevention, and treatment of hypertension. By adhering to these guidelines, healthcare providers can effectively reduce the risk of cardiovascular events and improve patient outcomes.
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