2010 Guidelines of the Taiwan Society of Cardiology for the Management of Hypertension

Abstract

Hypertension is one of the most important risk factors for atherosclerosis-related mortality and morbidity. In this document, the Hypertension Committee of the Taiwan Society of Cardiology provides new guidelines for hypertension management. The key messages are as follows. (1) The life-time risk for hypertension is 90%. (2) Both the increase in the prevalence rate and the relative risk of hypertension for causing cardiovascular events are higher in Asians than in Caucasians. (3) The control rate has been improved significantly in Taiwan from 2.4% to 21% in men, and from 5% to 29% in women in recent years (1995-2002). (4) Systolic and diastolic blood pressure (BP) = 130/80 mmHg are thresholds of treatment for high-risk patients, such as those with diabetes, chronic kidney disease, stroke, established coronary heart disease, and coronary heart disease equivalents (carotid artery disease, peripheral arterial disease, and abdominal aortic aneurysm). (5) Ambulatory and home BP monitoring correlate more closely with end-organ damage and have a stronger relationship with cardiovascular events than office BP monitoring, but the feasibility of home monitoring makes it a more attractive alternative. (6) Patients with masked hypertension have higher cardiovascular risk than those with white-coat hypertension. (7) Lifestyle changes should be encouraged in all patients, and include the following six items: S-ABCDE (Salt restriction; Alcohol limitation; Body weight reduction; Cessation of smoking; Diet adaptation; Exercise adoption). (8) When pharmacological therapy is needed, physicians should consider "PROCEED" (Previous experience of patient; Risk factors; Organ damage; Contraindication or unfavorable conditions; Expert or doctor judgment; Expense or cost; Delivery and compliance) to decide the optimal treatment. (9) The main benefits of antihypertensive agents are derived from lowering of BP per se, and are generally independent of the drugs being used, except that certain associated cardiovascular conditions might favor certain classes of drugs. (10) There are five major classes of drugs: thiazide diuretics; β-blockers; calcium channel blockers; angiotensin-converting enzyme inhibitors (ACEIs); and angiotensin receptor blockers (ARBs). Any one of these can be used as the initial treatment, except for β-blockers, which are only indicated in patients with heart failure, a history of coronary heart disease, and hyperadrenergic state. (11) A standard dose of any one of the five major classes of antihypertensive drugs can produce an ∼10-mmHg decrease in systolic BP (rule of 10) and a 5-mmHg decrease in diastolic BP (rule of 5), after placebo subtraction. (11) Combination therapy is frequently needed for optimal control of BP, and the amount of the decrease in BP by a two-drug combination is approximately the same as the sum of the decrease by each individual drug (∼20 mmHg in systolic BP and 10 mmHg in diastolic BP) if their mechanisms of action are independent, with the exception of the combination of ACEIs and ARBs. (13) An...

Effect of exercise on the maternal outcome in pregnancy of spontaneously hypertensive rats

“…The maternal BP levels are inversely related to the size and weight of the newborn 19 . These effects are caused by uteroplacental hypoperfusion consequent to high BP 45 . The analysis of perinatal outcomes indicates that exercise did not affect the litter mean weight as compared with sedentary rats.…”

Medication Safety Management Among Elder with Hypertensive in Community

“…At present, drug treatment is still the principal means to control blood pressure [6][7][8], and some literatures reported that 90% of the patients with high blood pressure can control blood pressure at a safe level by taking drugs [9]. With the rapid development of medicine and pharmacy, new antihypertensive drugs appear constantly.…”

Bidirectional Adherence Changes and Associated Factors in Patients Switched From Free Combinations to Equivalent Single-Pill Combinations of Antihypertensive Drugs

“…2,3 In most countries, more than half of treated patients with hypertension are indeed on ≥2 drugs. 2,4 Moreover, patients with hypertension are often associated with other cardiovascular risk factors and comorbidities, which may further increase the pill burden.…”

“…2,3,6,7 In a recent meta-analysis of studies comparing the administration of antihypertensive SPCs with their corresponding free-drug combinations, the compliance rate was improved by 21% in patients receiving SPCs. 8 However, most evidences showing that SPCs were associated with improved adherence are from cohort studies with parallel group comparisons and without adjustments for comorbidities and concomitant medications.…”