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 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 health care 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 where the most simple and empirical care for hypertension-simply 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 for patients with hypertension in their communities.We have divided this brief document into the following sections:

Electrocardiographic detection of hypertensive left atrial enlargement in the presence of obesity: re-calibration against cardiac magnetic resonance

“…Indeed, performing an ECG in all subjects with hypertension is advised by the American Society of Hypertension and International Society of Hypertension (ASH/ISH) in their joint clinical practice guidelines, at least in part to assess for LAE (2). LAE has been demonstrated to be a marker of left ventricular (LV) diastolic dysfunction(3) and a predictor of the development of atrial fibrillation(4), congestive heart failure(5), stroke(6), myocardial infarction(7) and cardiac mortality (8).…”

Olmesartan‐based monotherapy vs combination therapy in hypertension: A meta‐analysis based on age and chronic kidney disease status

“…Guidelines such as those from ASH/ISH provide advice on specific drug selection by patient type 3. If the initial treatment is not sufficient to achieve BP goals, patients may be prescribed a higher dose of monotherapy up to a maximum dose or will need a second agent from a different drug class added to the initial drug choice.…”

“…Guidelines for blood pressure (BP) goals are under debate in the face of organizational recommendations and recent clinical trial data. Recommendations from the Eighth Joint National Committee (JNC 8),2 American Society of Hypertension (ASH)/International Society of Hypertension (ISH),3 and the European Society of Hypertension (ESH)/European Society of Cardiology (ESC) hypertension guidelines4 are broadly similar. They recommend a target BP goal of <140/90 mm Hg for patients younger than 60 years or for those with comorbidities (chronic kidney disease [CKD], diabetes mellitus, or history of cardiovascular disease) and a target BP goal of <150/90 mm Hg for older patients (aged ≥60 years).…”

“…General recommendations from JNC 8, ASH/ISH, and ESH/ESC for initial pharmacologic therapy choices after the failure of lifestyle interventions include angiotensin‐converting enzyme inhibitors, angiotensin II receptor blockers (ARBs), calcium channel blockers, β‐blockers, or thiazide‐type diuretics 2, 3, 4…”

A pressão arterial em idosos de uma academia da terceira idade

“…O controle de outras doenças também é necessário, pois tem relação importante com a hipertensão, como é o caso da apneia do sono. 12 O consumo excessivo de álcool está associado ao maior risco de acidente vascular cerebral, representando a complicação mais grave após surgir uma HAS. O etilismo associado ao tabagismo é considerado hoje uma das maiores causas de mortalidade cardiovascular do mundo.…”