Management Of Hypertension In Adults Research Articles

Thresholds and Targets for Hypertension Management in Adults With Type 2 Diabetes Should Remain at 130/80 mmHg: What's the Evidence?

Hypertension and diabetes are common comorbidities and are both modifiable risk factors for cardiovascular disease and death. Lowering blood pressure reduces target organ damage and prevents cardiovascular disease outcomes. The harmonized Canadian clinical practice guidelines for managing hypertension in people with diabetes provides health-behaviour advice and medical therapy recommendations for a threshold blood pressure of 130/80 mmHg and above and to target blood pressure to below 130/80 mmHg. We have reviewed the studies supporting these recommendations and others, and they appear to be at odds with the guidelines, including those for elderly people and patients with pre-existing cardiovascular disease.

2015 Evidence Analysis Library Evidence-Based Nutrition Practice Guideline for the Management of Hypertension in Adults

Hypertension (HTN) or high blood pressure (BP) is among the most prevalent forms of cardiovascular disease and occurs in approximately one of every three adults in the United States. The purpose of this Evidence Analysis Library (EAL) guideline is to provide an evidence-based summary of nutrition therapy for the management of HTN in adults aged 18 years or older. Implementation of this guideline aims to promote evidence-based practice decisions by registered dietitian nutritionists (RDNs), and other collaborating health professionals to decrease or manage HTN in adults while enhancing patient quality of life and taking into account individual preferences. The systematic review and guideline development methodology of the Academy of Nutrition and Dietetics were applied. A total of 70 research studies were included, analyzed, and rated for quality by trained evidence analysts (literature review dates ranged between 2004 and 2015). Evaluation and synthesis of related evidence resulted in the development of nine recommendations. To reduce BP in adults with HTN, there is strong evidence to recommend provision of medical nutrition therapy by an RDN, adoption of the Dietary Approaches to Stop Hypertension dietary pattern, calcium supplementation, physical activity as a component of a healthy lifestyle, reduction in dietary sodium intake, and reduction of alcohol consumption in heavy drinkers. Increased intake of dietary potassium and calcium as well as supplementation with potassium and magnesium for lowering BP are also recommended (fair evidence). Finally, recommendations related to lowering BP were formulated on vitamin D, magnesium, and the putative role of alcohol consumption in moderate drinkers (weak evidence). In conclusion, the present evidence-based nutrition practice guideline describes the most current recommendations on the dietary management of HTN in adults intended to support the practice of RDNs and other health professionals.

Description of Antihypertensive Medication Use in a Pediatric Practice: Single and Multiple Antihypertensive Medication Therapy.

Prescription of multiple antihypertensive medications for the treatment of essential hypertension (HTN) has been well described in adults but not in children and adolescents. The authors describe the frequency with which children with essential HTN are prescribed a single vs two or more concomitantly administered antihypertensive medications. They also describe demographic features and comorbidities associated with the prescription of a single vs multiple antihypertensive medications. Multiple antihypertensive medication use in the management of pediatric HTN, as in the management of adult HTN, is not uncommon. In this single-center, retrospective study of 113 children with essential HTN, 28% of children were concomitantly prescribed two or more antihypertensive medications for poorly controlled blood pressure following prescription of a single medication. Demographic and comorbid conditions associated with the prescription of more than one antihypertensive medication include advanced hypertensive stage, race, and a family history of HTN.

Guideline for the diagnosis and management of hypertension in adults - 2016.

The National Heart Foundation of Australia has updated the Guide to management of hypertension 2008: assessing and managing raised blood pressure in adults (updated December 2010). Main recommendations For patients at low absolute cardiovascular disease risk with persistent blood pressure (BP) ≥ 160/100 mmHg, start antihypertensive therapy. The decision to treat at lower BP levels should consider absolute cardiovascular disease risk and/or evidence of end-organ damage, together with accurate BP assessment. For patients at moderate absolute cardiovascular disease risk with persistent systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg, start antihypertensive therapy. Treat patients with uncomplicated hypertension to a target BP of <140/90 mmHg or lower if tolerated. Changes in management as a result of the guideline Ambulatory and/or home BP monitoring should be offered if clinic BP is ≥ 140/90 mmHg, as out-of-clinic BP is a stronger predictor of outcome. In selected high cardiovascular risk populations, aiming for a target of <120 mmHg systolic can improve cardiovascular outcomes. If targeting <120 mmHg, close follow-up is recommended to identify treatment-related adverse effects including hypotension, syncope, electrolyte abnormalities and acute kidney injury. Why the changes have been made A 2015 meta-analysis of patients with uncomplicated mild hypertension (systolic BP range, 140-169 mmHg) demonstrated that BP-lowering therapy is beneficial (reduced stroke, cardiovascular death and all-cause mortality). A 2015 trial comparing lower with higher blood pressure targets in selected high cardiovascular risk populations found improved cardiovascular outcomes and reduced mortality, with an increase in some treatment-related adverse events.

Antihypertensive drugs

Antihypertensive drugs

Antihypertensive Drugs and Male Sexual Dysfunction

Published clinical practice guidelines have addressed antihypertensive therapy and sexual dysfunction (SD) in many different ways. In this systematic review, we evaluated guidelines that address antihypertensive drug-associated SD, guideline recommendations, and recent guideline trends. Thirty sets of guidelines for hypertension management in adults that had been published in the English language since 2000 were reviewed. The primary outcome measure was antihypertensive-associated SD potential, which was independently evaluated using specific questions by 2 authors in a nonblinded standardized manner. Sexual dysfunctions associated with thiazide-class diuretics, β-blockers, and centrally acting sympathoplegics were addressed by half of the guidelines reviewed. There is no clarity on β-blockers and thiazide-class diuretics because one-third of the guidelines are vague about individual β-blockers and diuretics, and there is no statement on third-generation β-blockers and thiazide-like diuretics that can improve erectile function. The revised guidelines never use terms such as loss of libido, ejaculatory dysfunction, lack of orgasm, and priapism. Summary versions of guidelines are inadequate to reflect the key interpretation of the primary guidelines on SD associated with antihypertensives, even in the major guidelines that were updated recently. Therapeutic issues such as exploring SD in clinical history, assessing SD prior to and during treatment with antihypertensives, substituting the offending agents with alternatives that possess a better safety profile, intervening with phosphodiesterase-5 inhibitors, and avoiding the concomitant use of nitrovasodilators are superficially addressed by most guidelines, with the exception of 2013 European Society of Hypertension/European Society of Cardiology and Seventh Joint National Committee recommendations. Future guideline revisions, including both full and summary reports, should provide a balanced perspective on antihypertensive-related SD issues to improve the impact of hypertension treatment guidelines on patient care and quality of life.

Treatment of hypertension in chronic kidney disease: does one size fit all? A narrative review from a nephrologist's perspective.

The treatment of hypertension in patients with chronic kidney disease is still controversial, particularly in regards to the intensity of blood pressure lowering. The 2014 guidelines for the management of hypertension in adults released by the Eighth Joint National Committee (JNC 8) have sparked criticism from nephrologists, and various societies have issued differing guidelines. In this article we present a few case vignettes and provide a brief review of the various guidelines, particularly in regards to patients with chronic kidney disease. We review some of the landmark trials that have influenced guidelines and the practice of nephrology, as well as the limitations of the evidence on which the current guidelines are based. We discuss treatment for the patients presented in the case vignettes in light of the guidelines and the evidence. Finally, it will be clear that there is no single BP goal or single drug that is appropriate for all patients, and that our knowledge base for optimal treatment of hypertension in chronic kidney disease is still limited.

Evidence based guideline for the management of hypertension in adults: appropriate approach

Abstract not available DOI: http://dx.doi.org/10.3329/jdmc.v22i2.21516 J Dhaka Medical College, Vol. 22, No.2, October, 2013, Page 108

Hypertension: diagnosis, assessment and management.

Hypertension is a serious and common condition, the prevalence of which is set to rise given the increase in the ageing population, sedentary lifestyles and obesity. This article reviews the management of primary hypertension in adults, with reference to the National Institute for Health and Care Excellence guidelines. Diagnosis using clinic, ambulatory and home blood pressure (BP) monitoring, risk factors , BP targets, lifestyle advice, drug treatment and patient education are also discussed.

Dietary management of adult hypertension by the duration of its diagnosis (628.10)

This research focuses on dietary behaviors for hypertension management which emphasize the importance of healthy eating such as nutrition intake and food choices. These modifiable dietary behaviors can explain a large part of chronic disease morbidity and mortality at all ages in men and women. The study examines whether age at hypertension diagnosis is associated with nutrition intakes and food availability at home. With new data availability about age at hypertension diagnosis in the National Health and Nutrition Examination Survey (NHANES) since 2007, the pooled four repeated cross‐sectional waves of NHANES from 2007‐2010 are used (n=4,287). For the empirical models, the study employs seemingly unrelated probit regression to estimate the dietary choices of individuals with hypertension based on the time since diagnosis. We hypothesize that more recent diagnoses of hypertension provide individuals with hypertension an incentive to engage in better dietary behaviors and healthier food availability at home, such as lower total caloric intake and a greater presence of fruits and vegetables at home. Furthermore, we hypothesize that individuals’ compliance with a diet can decline as time living with a disease diagnosis increases. That is, the shorter the elapsed time since diagnosis of hypertension, diagnosed individuals will be more likely to respond positively with changes in dietary behaviors. Since the long term change in dietary behaviors is known to be challenging, newly diagnosed individuals may be more willing to engage in healthier diets. This study will provide that the effect of the duration of diagnosed hypertension on modifying diet can better address hypertension management. Considering the cost of poor dietary behaviors is higher for individuals with hypertension, it is important to understand the time varying effect of their dietary compliance as a key indicator of the recommended hypertension management.

Update: ambulatory blood pressure monitoring in children and adolescents: a scientific statement from the American Heart Association.

Ambulatory blood pressure monitoring (ABPM) has established roles in the evaluation and management of hypertension in adults but has only been applied to children and adolescents more recently.1 In 2008, the American Heart Association (AHA) issued the first set of consensus recommendations for performance and interpretation of ABPM in pediatrics. Since then, ABPM has found increasing use in children and adolescents, as recently summarized.2 The present document updates the 2008 AHA statement on the use of ABPM in the pediatric population3 with additional data published since the release of that report and also presents a revised interpretation schema. Because no outcome studies are yet available relating ABPM levels in children to outcomes such as myocardial infarction or stroke, these guidelines are largely driven by expert opinion, although they are also informed by available pediatric data on ABPM and surrogate markers of cardiovascular disease. ### Epidemiology of Hypertension High blood pressure (BP) is the leading risk factor–related cause of death throughout the world, accounting for 12.8% of all deaths, including 51% of stroke deaths and 45% of coronary heart disease deaths.4 In the United States, 33.0% of adults >20 years of age have hypertension.5 As our population continues to age, this will only increase, because 90% of people with normal BP at age 55 years will go on to develop hypertension in their lifetimes.6 The prevalence of hypertension in youths is also on the rise. US National Health and Nutrition Examination Survey (NHANES) data from 1963 to 2002 showed a 2.3% increase in prehypertension and a 1% increase in hypertension from 1988 to 1999, with higher rates in non-Hispanic blacks and Mexican Americans.7 In fact, the entire distribution of childhood BP has shifted upward in the United States by 1.4 mm Hg for systolic BP (SBP) and 3.3 …

2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults

Hypertension is the most common condition seen in primary care and leads to myocardial infarction, stroke, renal failure, and death if not detected early and treated appropriately. Patients want to be assured that blood pressure (BP) treatment will reduce their disease burden, while clinicians want guidance on hypertension management using the best scientific evidence. This report takes a rigorous, evidence-based approach to recommend treatment thresholds, goals, and medications in the management of hypertension in adults. Evidence was drawn from randomized controlled trials, which represent the gold standard for determining efficacy and effectiveness. Evidence quality and recommendations were graded based on their effect on important outcomes. There is strong evidence to support treating hypertensive persons aged 60 years or older to a BP goal of less than 150/90 mm Hg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than 90 mm Hg; however, there is insufficient evidence in hypertensive persons younger than 60 years for a systolic goal, or in those younger than 30 years for a diastolic goal, so the panel recommends a BP of less than 140/90 mm Hg for those groups based on expert opinion. The same thresholds and goals are recommended for hypertensive adults with diabetes or nondiabetic chronic kidney disease (CKD) as for the general hypertensive population younger than 60 years. There is moderate evidence to support initiating drug treatment with an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic in the nonblack hypertensive population, including those with diabetes. In the black hypertensive population, including those with diabetes, a calcium channel blocker or thiazide-type diuretic is recommended as initial therapy. There is moderate evidence to support initial or add-on antihypertensive therapy with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in persons with CKD to improve kidney outcomes. Although this guideline provides evidence-based recommendations for the management of high BP and should meet the clinical needs of most patients, these recommendations are not a substitute for clinical judgment, and decisions about care must carefully consider and incorporate the clinical characteristics and circumstances of each individual patient.

Pharmacological management of hypertension in adults: updates from Eighth Joint National Committee

The choice of first-line antihypertensive drug(s) is a matter of intensive research despite the availability of data from large, randomized, and controlled clinical trials. The Eighth Joint National Committee (JNC) guideline on management of high blood pressure (BP) in adults has significant updates over the earlier guidelines.

Using the Latest Evidence to Manage Hypertension

Hypertension (HTN) is a chronic condition that is frequently the precursor to cardiovascular and metabolic conditions. This article reviews the current literature on the management of HTN in adults, including diagnosis, determination of treatment goals, implementation of treatment regimens, and differentiation between difficult-to-treat and truly resistant HTN. Information is summarized about how nurse practitioners can empower patients to use home blood pressure monitoring. The article incorporates discussion about new research in HTN management and provides insight into the forthcoming Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure report.

NICE recommendations on the management of hypertension

Here, Belinda Linden reviews the key areas covered by the recent National Institute for Health and Care Excellence quality standard for the management of hypertension in adults

Management of hypertension in adults: the 2013 French Society of Hypertension guidelines

To improve the management of hypertension in the French population, the French Society of Hypertension has decided to issue a new set of guidelines that include the following practical characteristics: usefulness for clinical practice, short, easy-to-read format, comprehensive writing for non-physicians, wide dissemination among healthcare professionals and the hypertensive population, assessment of their impact among healthcare professionals and with regard to public health goals. These guidelines, so-called the appointments of the hypertensive patient, include 15 recommendations, divided into three chapters, according to the timing of the medical management: prior to treatment initiation, the initial treatment plan (first 6 months) and the long-term care plan (beyond 6 months). We hope that a vast dissemination of these simple guidelines will help to improve hypertension control in the French population from 50% to 70%, an objective expected to be achieved in 2015 in France.

Hypertension-related, but not necessarily age-related

British Journal of Hospital MedicineVol. 73, No. 7 CorrespondenceHypertension-related, but not necessarily age-relatedOscar MP JolobeOscar MP JolobeSearch for more papers by this authorOscar MP JolobePublished Online:16 Aug 2013https://doi.org/10.12968/hmed.2012.73.7.415AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Barnes D, Yaffe K (2011) The projected effect of risk factor reduction on Alzheimer's disease prevalence. Lancet Neurol 10: 819–28 Crossref, Medline, Google ScholarGo AS, Hylek EM, Philips KA, Chang Y, Henault LE, Selby JV, Singer DE (2001) Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 285: 2370–5 Crossref, Medline, Google ScholarNational Institute for Health and Clinical Excellence (2011) Hypertension. Management of hypertension in adults in primary care. Clinical guideline 127. http://guidance.nice.org.uk/CG127 (accesssed 9 May 2012) Google ScholarUS Preventive Services Task Force (2003) Screening for high blood pressure. Recommendations and rationale. Am J Prev Med 25: 159–64 Crossref, Medline, Google Scholar FiguresReferencesRelatedDetails 1 July 2012Volume 73Issue 7ISSN (print): 1750-8460ISSN (online): 1759-7390 Metrics History Published online 16 August 2013 Published in print 1 July 2012 Information© MA Healthcare LimitedPDF download

Is It Possible to Manage Hypertension and Evaluate Therapy Without Ambulatory Blood Pressure Monitoring?

In the management of patients with hypertension, blood pressure (BP) has been traditionally measured in the physician's office. The contribution of ambulatory BP monitoring (ABPM) to the management of hypertensive patients has been increasingly recognized through clinical and epidemiological research. Ambulatory BP monitoring can enhance the ability to detect white-coat or masked hypertension, determine the absence of nocturnal dipping status, and evaluate BP control in patients on antihypertensive therapy. Recently, the United Kingdom National Clinical Guideline Centre published guidelines for the clinical management of primary hypertension in adults, recommending the routine use of ABPM to make the initial diagnosis of hypertension. While the advantages of ABPM are apparent from a clinical perspective, its use should be considered in relation to the cost of the equipment, data evaluation, and staff training as well as the possible inconvenience to the patient. In this review, we summarize the clinical importance of ABPM and discuss the current guidelines for establishing the diagnosis of hypertension.

Management of hypertension in adults in primary care: NICE guideline

Hypertension is common and is one of the leading causes of cardiovascular events such as stroke and ischaemic heart disease. It is responsible for approximately 12% of consultations in primary care. This is a summary of the key points in the 2011 National Institute for Health and Clinical Excellence (NICE) hypertension guideline.1 This is an update of NICE clinical guideline 18, which was first published in 2004 and was partially updated in 2006 (clinical guideline 34). The 2006 and 2011 updates were developed in collaboration with the British Hypertension Society (BHS). The areas included for updating were selected because of new evidence that might change existing recommendations. These included the use of ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM) in diagnosis; the place of new thresholds and targets for treatment; and a re-examination of the position of angiotensin-converting inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), calcium-channel blockers (CCBs), and diuretics in the treatment algorithm. Consideration of differences in management for people of various ages and ethnicity, as well as how to treat resistant hypertension, were also included. The management of blood pressure in people with diabetes was not included in this guideline. ### Diagnosis The diagnosis of hypertension uses both clinic blood pressure monitoring (CBPM) and ABPM readings (Box 1). If blood pressure measured in the clinic is 140/90 mmHg or higher, a second measurement should be taken during the consultation. If the second measurement is substantially different from the first, take a third measurement. The lower of the last two measurements should be recorded as …

Diagnosing Hypertension—Implications of the 2011 NICE Guidance

The accurate diagnosis of hypertension is a difficult issue. The 2006 National Institute for Health and Clinical Excellence (NICE) guidance for the management of hypertension in adults in primary care recommended the use of clinic measurements taken on multiple occasions. However, this process was both protracted and potentially inaccurate. As a result, some patients may have been inappropriately treated with anti-hypertensive drugs causing both unnecessary side effects and excess costs to the National Health Service (NHS). Others may not have been treated at all resulting in additional cardiovascular events. Given this, NICE has recently updated its guidance in this area to include an increasing role for ‘out-of-office’ techniques, including ambulatory and home monitoring.