Clinical Practice Guidelines for the Management of Hypertension in the Community

Abstract

These guidelines have been written to provide a straightforward approach to managing hypertension in the community. We have intended that this brief curriculum and set of recommendations be useful not only for primary care physicians and medical students, but for all professionals who work as hands-on practitioners.We are aware that there is a great variability in access to medical care among communities. Even in so-called wealthy countries, there are sizable communities in which economic, logistic, and geographic issues put constraints on medical care. And, at the same time, we are been reminded that even in countries with highly limited resources, medical leaders have assigned the highest priority to supporting their colleagues in confronting the growing toll of devastating strokes, cardiovascular events, and kidney failure caused by hypertension.Our goal has been to give sufficient information to enable healthcare practitioners, wherever they are located, to provide professional care for people with hypertension. All the same, we recognize that it will often not be possible to carry out all of our suggestions for clinical evaluation, tests, and therapies. Indeed, there are situations in which the most simple and empirical care for hypertensionsimply distributing whatever antihypertensive drugs might be available to people with high blood pressure -is better than doing nothing at all. We hope that we have allowed sufficient flexibility in this statement to enable responsible clinicians to devise workable plans for providing the best possible care of hypertension in their communities.We have divided this brief document into the following sections:1. General introduction 2. Epidemiology 3. Special issues with black patients (African ancestry) 4. How is hypertension defined? 5. How is hypertension classified? 6. Causes of hypertension 7. Making the diagnosis of hypertension 8. Evaluating the patient 9. Physical examination 10. Tests

US Hypertension Management Guidelines: A Review of the Recent Past and Recommendations for the Future

“…11, 14, 21, 22, 23 Unlike the JNC 8 panel's recommendations, the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) add another variable of frailty, likely due to the fact that trials such as HYVET attempted to exclude frail patients such as those with dementia or requiring nursing home care 12. They recommend a tailored approach for the fragile elderly patient <80 years of age by using individualized targets.…”

“…In the black population with hypertension, CCBs and thiazide diuretics generally tend to be favored as initial therapy over renin‐angiotensin system blockers 13, 14, 45. The evidence for this recommendation comes from ALLHAT, which showed in prespecified subgroup analysis that black patients treated with lisinopril had higher rates of stroke, CVD, and HF plus 4 mm Hg higher SBP compared with those treated with chlorthalidone 49…”

Nifedipine GITS/Candesartan Combination Therapy Lowers Blood Pressure Across Different Baseline Systolic and Diastolic Blood Pressure Categories: DISTINCT Study Subanalyses

“…Management guidelines8, 9, 10 support this view, with the latest guidelines from the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) recommending initial 2‐drug combination therapy for patients at high CV risk or with markedly high BP 8. One combination therapy approach recommended by guidelines8 that provides both BP and CV benefits is a calcium channel blocker (CCB)/renin‐angiotensin system (RAS) blocker.…”

Apparent Treatment-Resistant Hypertension and Chronic Kidney Disease: Another Cardiovascular-Renal Syndrome?

“…To effectively exclude causes of pseudoresistant hypertension, current guidelines recommend obtaining either home BPs or, if available, ambulatory BPs. 6,7 Furthermore, patient compliance with antihypertensive therapy should be assessed by medication reconciliation and questioning family members. 7 Definition of aTRH aTRH has been coined to comprise patients meeting the AHA definition of resistant hypertension in whom causes for pseudoresistance have not been thoroughly investigated.…”

“…6,7 Furthermore, patient compliance with antihypertensive therapy should be assessed by medication reconciliation and questioning family members. 7 Definition of aTRH aTRH has been coined to comprise patients meeting the AHA definition of resistant hypertension in whom causes for pseudoresistance have not been thoroughly investigated. 8 Given that the vast majority of studies on resistant hypertension in the literature do not completely address pseudoresistance, we will use the term aTRH for the rest of this review unless pseudoresistance has been specifically excluded.…”