Highlights of the 2022 Vietnamese Society of Hypertension guidelines for the diagnosis and treatment of arterial hypertension

Abstract

Hypertension is uncontrolled in over 50% hypertensive population in Vietnam which indicated a compelling need for new hypertension guidelines. The highlights were composed of three parts: the diagnosis of arterial hypertension, the recommendation of home blood pressure monitoring, and the treatment of hypertension. Our guideline applied flexibility based upon the "essential" and "optimal" concepts in the diagnosis and management of hypertensive patients according to the socio-economic status of Vietnam. Hypertension is defined as an office systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg which is equivalent to a 24-hr ambulatory blood pressure monitoring average of ≥130/80 mmHg or home blood pressure monitoring average of ≥135/85 mmHg. We established an integrated hypertensive diagnostic algorithm for adults with the optimal option by the role of out-of-office blood pressure measurement, especially home blood pressure monitoring, which is fully recommended in this guideline. The threshold and target of hypertension treatment were individualized in safety range and effective evidence-based medicine. We also update for the management of resistant hypertension, hypertension in diabetic patients, hypertension with heart failure, and with other comorbidities. Vietnam has tried on the best strategy for improving the control of hypertension and recently received several achievements in the world, especially in the Asian region. Because the conditions for conducting our national data have not been fully conducted, we have to adapt from existing guidelines so there are still certain limitations that need to be supplemented and adjusted in the upcoming version.

Hypertensive emergencies in Asia: A brief review

“…As shown in Table 2, the Chinese Hypertension League and the Chinese Society of Cardiology did not specify how quickly to lower blood pressure 15 . In contrast, the other guidelines did 13,16–20 . These guidelines suggested lowering blood pressure by 20%–25% from its initial point.…”

“…The management discussed in this review was solely based on the guidelines' recommendations. The national practice guidelines for hypertension in China, South Korea, Japan, India, Pakistan, Malaysia, Indonesia, Vietnam, and Thailand discussed the management of hypertensive emergencies under the specific population section 12–20 . Each guideline emphasized the acute phase treatment in patients with hypertensive emergency based on TOD, as shown in Table 2.…”

“…According to Korean recommendations, the target blood pressure should be less than 140 mmHg within the first hour 12 . Furthermore, both blood pressure (SBP, 100–120 mmHg) and heart rate (HR, less than 60 beats per minute) should be reduced significantly as soon as possible, according to Malaysian, Indonesian, and Vietnamese guidelines 17,19–20 . The Japanese guidelines, on the other hand, did not establish a target HR 13 .…”

“…The Malaysian guidelines advocated lowering blood pressure within 3–24 h as a target for AKI. However, no specific medication was proposed, 17 while the Vietnamese guidelines recommended labetalol and nicardipine as the preferred medications 20 …”

“…The national practice guidelines for hypertension in China, South Korea, Japan, India, Pakistan, Malaysia, Indonesia, Vietnam, and Thailand discussed the management of hypertensive emergencies under the specific population section. [12][13][14][15][16][17][18][19][20] Each…”