Lowering blood pressure is a priority in Brazil and worldwide

Abstract

Cardiology (ACC) launched new guidelines for detecting, treating and controlling hypertension. 1 Recommendations from US researchers have been reaching significant broad audiences through several guidelines that have been disseminated worldwide. Starting in the 1970s, the US National Institutes of Health (NIH) issued seven guidelines relating to management of high blood pressure 2 . However, in 2014, the NIH declined to issue new instructions and asked these American professional associations to update the approach to hypertension.The cornerstone of the new guidelines has come from the results of the Systolic Blood PressureIntervention Trial (SPRINT). This was a large randomized clinical trial that revealed that the risks of all causes of deaths and of new cases of cardiovascular diseases were lower only at blood pressure levels lower than the previous cutoff of 140 mmHg for systolic blood pressure (SBP) and 90 mm for diastolic blood pressure (DBP). 3The data from SPRINT reaffirmed what had been seen in several observational studies thatshowed that people with prehypertension were at higher risk. The most relevant data had come from the Framingham Heart Study in 2001: the 10-year cumulative incidence of cardiovascular disease among people with prehypertensive blood pressure levels (SBP of 130 to 139 mmHg, DBP of 85 to 89 mmHg, or both) in the age range from 35 to 64 years was 4% (women) and 8% (men); and at ages of 65 years and over, the incidence was 18% (women) and 25% (men). From our point of view, there are two essential points to be discussed with all physicians and healthcare providers in Brazil.1. The diagnosis of hypertension does not need to be immediate. A sequence of blood pressure measurements taken at home or in an ambulatory setting should be the gold standard, and not the office blood pressure. At first glance, the impression obtained is that the range of blood pressures that are deemed to be hypertensive has been significantly increased. However, the spread of home and ambulatory blood pressure measurements will reduce the level of values obtained, in comparison with the blood pressure measured in the physician's office, which was the source of the survey data addressing hypertension.2. The aim in lowering high blood pressure is to reduce the incidence and recurrence of cardiovascular diseases. Consequently, a general approach to risk factors is fundamental for all patients and mandatory for people who are tagged with the diagnosis of hypertension.Thus, the need to calculate the overall risk will demand information about smoking, diabetes, renal function and previous cardiovascular diseases.It is always necessary to remember that the most crucial issue regarding lowering of blood pressure to curb the burden of cardiovascular diseases relates to primordial prevention. Thus, there remains I MD, DrPH. Full Professor,