The Evolution of Hypertension Guidelines Over the Last 20+ Years: A Comprehensive Review

Abstract

Hypertension is the most common modifiable risk factor for cardiovascular and cerebrovascular diseases. In the last two decades, the guidelines have evolved tremendously from areas with no recommendations for screening or treatment to targeted recommendations for some at-risk groups. We sought to go through the literature that provided guidelines for the management of hypertension at any point in time over the last 22 years from 2000 to 2022. We searched four databases: PubMed, Embase, Google Scholar, and Cochrane, using specified search terms. The keywords used were "hypertension" and "guidelines." We combined them using the Boolean operators (AND, OR) and searched for articles. A total of 2461 publications were initially identified; 348 publications were excluded after screening for full-text availability. The full-text articles were further filtered based on title and abstract screening. Following this, a total of 1443 articles were excluded. The remaining 670 full-text articles were assessed for eligibility. Of the 670 full-text articles, 480 were excluded based on exclusion criteria, and following the full-text article screening, 190 articles met the final inclusion criteria. Most of these guideline evolutions concerned establishing and adjusting thresholds for the subgroups of the elderly population and patients with diabetic kidney disease, chronic kidney disease, and stroke. Furthermore, the medications of choice are now guided by the stage of disease, presence or absence of comorbidities, and other relevant information, as opposed to ethnicity, which was previously a heavy yardstick for medication choice.

Wellens Syndrome: A Possible Precursor

“…[1][2][3][4]. Like previously recorded examples of Wellen's syndrome in several classic documentations [5][6][7][8][9], our patient had a history of high blood pressure, diabetes, and hyperlipidemia, which predisposed him to this pre-infarction condition, comparable to those that cause coronary artery disease. Postulations have been made that the alteration in the EKG is accounted for by the reperfusion of the ischemic myocardium owing to the reduction of spasm in the proximal LAD artery.…”

“…Usually, the assessment and diagnosis include a triad: primarily, ECGs follow one of two patterns (type A with biphasic T-waves in V2-V3 or type B with negative T waves in V2-V4) with a minimally elevated or isoelectric ST-segment in a patient who often has no acute pain. Compared with documented cases of approximately one-quarter of these patients having these changes in V1 and two-thirds having these changes in V4 [5][6][7][8], our patient presented with classic wave patterns in V2-V4. In a Chinese study that looked back at 3528 individuals who had angioplasty between 2017 and 2019, 5.7% (200) of them fit the criteria for Wellen's syndrome using this EKG pattern [9].…”

“…Postulations have been made that the alteration in the EKG is accounted for by the reperfusion of the ischemic myocardium owing to the reduction of spasm in the proximal LAD artery. Still, the cause of Wellens' syndrome remains unclear [5][6][7][8][9]. Furthermore, these ECG changes representing a preinfarction state are commonly associated with unstable angina [1][2][3][4].…”

“…Early percutaneous coronary intervention is the preferred treatment modality [1][2][3][6][7][8][9][10] for NSTE acute coronary syndrome, especially in pain-free patients like this patient. Still, in an ideal world and at the peak of the COVID-19 era, few patients received such prompt percutaneous intervention.…”

“…Still, in an ideal world and at the peak of the COVID-19 era, few patients received such prompt percutaneous intervention. Post-catheterization outcomes have also been very successful for those who received these quick interventions, but a delay in intervention may lead to anterior wall infarction and, in some cases, death [5][6][7][8][9]12].…”