2020 International Society of Hypertension global hypertension practice guidelines

Unger, Thomas; Borghi, Claudio; Charchar, Fadi J.; Khan, Nadia; Poulter, Neil; Prabhakaran, Dorairaj; Ramiréz, Agustín J.; Schlaich, Markus P.; Stergiou, George S.; Tomaszewski, Maciej; Wainford, Richard D; Williams, Bryan; Schutte, Aletta E.

doi:10.1097/hjh.0000000000002453

Cited by 547 publications

(381 citation statements)

References 132 publications

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“…When classifying different groups of patients, we mainly rely on the 2018 Chinese Guidelines for the Management of Hypertension (25), which may miss some risk stratifications of in guidelines of other countries. When implementing this study, we will also discuss the influence of different guidelines [for example, ISH 2020 guidelines for HTA management and 2018 ESC/ESH guideline (48,49)].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and Efficiency of Non-drug Therapy Among Community-Dwelling Adults With Hypertension in China: A Protocol for Network Meta-Analysis and Cost-Effectiveness Analysis

Shao

Zhou

et al. 2021

Front. Med.

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Introduction: The Chinese government has established a nationwide community-based chronic disease management program since 2009 with hypertension a vital part of it. Though drugs have been proven effective with hypertensive patients, they bring economic burden as well, especially for those who with elevated blood pressure and are potentially eligible for national programs. When the effectiveness of pharmacotherapy-only interventions remains uncertain on these patients, non-pharmacological interventions have demonstrated non-inferior effectiveness and may have economic advantages. To date, there rarely are evidences on the effectiveness and cost-effectiveness of non-pharmacological treatment in comparison with pharmacological interventions for patients with varying severity of blood pressure. This study aims to propose a study for a network meta-analysis and cost-effectiveness analysis to explore what kind of intervention is potentially effective and cost-effective to four specific patient groups, stage I-III hypertensive patients and patients with elevated blood pressure, and to provide recommendations for hypertensive management to Chinese decision makers.Methods: We will systematically search databases (MEDLINE, PubMed, Cochrane Library, etc.,) for randomized controlled trials and observational studies with qualified study design in recent decade that assess the effectiveness of non-pharmacological, pharmacological, or combined intervention aimed at adult populations who are diagnosed with the above four types of hypertension in China. The effectiveness outcomes will include changes in SBP/DBP, rate of comorbidities, mortality, and health related quality of life. We will use network meta-analysis to compare and rank effectiveness of different interventions. Subgroup analyses and meta-regression analyses will be performed to analyze and explain heterogeneity. The economic outcome will include cost-effectiveness based on simulation results from Markov models. Under study perspective of Chinese health system, life-time direct cost will be included.Discussion: This study aims to compare and rank the effectiveness and cost-effectiveness of pharmacological, non-pharmacological and combined interventions for stage I–III hypertensive patients and those who with elevated blood pressure. Compared to existing studies, this comprehensive synthesis of relevant evidences will influence future practice with better efficiency and generalizability for community-based hypertensive management programs in China. The study might also be valuable for other low- and middle-income countries to find their own solutions.PROSPERO registration number: CRD42020151518

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Section: Discussionmentioning

confidence: 99%

Effectiveness and Efficiency of Non-drug Therapy Among Community-Dwelling Adults With Hypertension in China: A Protocol for Network Meta-Analysis and Cost-Effectiveness Analysis

Shao

Zhou

et al. 2021

Front. Med.

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“…This condition affects the high-income more than the low-income population and men more than women. The prevalence of blood pressure increases and adverse impacts on cardiovascular morbidity and mortality are increasing globally regardless of income ( Figure 3) [4].…”

Section: Discussion Pathophysiologymentioning

confidence: 99%

Malignant Hypertension Without End-Organ Damage Secondary to Stressful Condition in a Female

Hussain¹,

Fadel

2020

Cureus

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Malignant hypertension (hypertensive emergency), is an extreme elevation of blood pressure under certain conditions that can lead to organ damage and other serious consequences. It is a common condition that affects about one in three Americans, according to the Centers for Disease Control and Prevention. An elevation of systolic blood pressure above 180 mmHg and diastolic blood pressure above 120 mmHg is considered a hypertensive emergency. This article addresses the case of a 61-year-old female patient who presented to the ER with a semicomatose and gasping condition and response to painful stimuli with an unclear voice. She also had unstable vital signs, with a blood pressure of 370/200 mmHg, a pulse rate of 115, a respiratory rate of 22, and a pulse oximetry of 96%, but no fever. Her son provided a brief history and reported that a stressful condition had occurred at home one hour before; she had begun to scream and been brought to the ER by ambulance in the condition described above. Cardiac monitoring and an electrocardiograph were performed and indicated a normal condition besides the unstable vital signs. Oxygen was administered via a nasal cannula with 20 mg of intravenous hydralazine, and the patient's blood pressure improved progressively. Moreover, she regained consciousness with no end-organ damage. A hypertensive emergency is usually associated with end-organ damage, such as heart, kidney, eye, or brain damage. However, in this case, despite the extreme elevation of her blood pressure, the patient suffered no organ damage. It is essential to manage the extreme elevation of blood pressure as soon as possible and monitor the patient for consequences.

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“…Many current hypertension guidelines do not contain specific recommendations on the use of telemedicine for hypertension management [98][99][100][101][102][103][104]. As summarized in TABLE S8, only American guidelines clearly recommend the use of telemedicine to confirm the diagnosis of hypertension and as an adjunct on top of the standard intervention to improve BP control and adherence [6].…”

Section: Final Recommendationsmentioning

confidence: 99%

Evidence and Recommendations on the Use of Telemedicine for the Management of Arterial Hypertension

et al. 2020

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Telemedicine allows the remote exchange of medical data between patients and healthcare professionals. It is used to increase patients’ access to care and provide effective healthcare services at a distance. During the recent coronavirus disease 2019 (COVID-19) pandemic, telemedicine has thrived and emerged worldwide as an indispensable resource to improve the management of isolated patients due to lockdown or shielding, including those with hypertension. The best proposed healthcare model for telemedicine in hypertension management should include remote monitoring and transmission of vital signs (notably blood pressure) and medication adherence plus education on lifestyle and risk factors, with video consultation as an option. The use of mixed automated feedback services with supervision of a multidisciplinary clinical team (physician, nurse, or pharmacist) is the ideal approach. The indications include screening for suspected hypertension, management of older adults, medically underserved people, high-risk hypertensive patients, patients with multiple diseases, and those isolated due to pandemics or national emergencies.

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2020 International Society of Hypertension global hypertension practice guidelines

Cited by 547 publications

References 132 publications

Effectiveness and Efficiency of Non-drug Therapy Among Community-Dwelling Adults With Hypertension in China: A Protocol for Network Meta-Analysis and Cost-Effectiveness Analysis

Effectiveness and Efficiency of Non-drug Therapy Among Community-Dwelling Adults With Hypertension in China: A Protocol for Network Meta-Analysis and Cost-Effectiveness Analysis

Malignant Hypertension Without End-Organ Damage Secondary to Stressful Condition in a Female

Evidence and Recommendations on the Use of Telemedicine for the Management of Arterial Hypertension

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