The Novelty of the 2015 Guidelines of the Taiwan Society of Cardiology and the Taiwan Hypertension Society for the Management of Hypertension

Abstract

The prevalence rate of hypertension in Asian countries grows faster than in other parts of the world, where stroke exceeds coronary heart disease in causing morbidities and mortalities. The optimal management of hypertension is therefore an especially important task in Asia. In a transparent and rigorous guideline development process, the most updated information available on the management of hypertension was summarized in the 2015 Taiwan Society of Cardiology (TSOC)/Taiwan Hypertension Society (TSH) hypertension guideline. In contradiction with the ESH/ESH joint hypertension guidelines and the 2014 Joint National Committee (JNC) report, this updated guideline suggests some different blood pressure (BP) targets. In brief, the BP target is 150/90 mm Hg for very elderly patients (≥ 80 years), 130/80 mm Hg for patients with diabetes, coronary heart disease, proteinuric chronic kidney disease or those receiving antithrombotics for stroke prevention, and 140/90 mm Hg for all the other hypertension patients with or without the aforementioned comorbidities. To facilitate the adherence to the guideline, the following was proposed: mnemonics for lifestyle modifications: S-ABCDE (Sodium restriction, Alcohol limitation, Body weight reduction, Cigarette smoking cessation, Diet adaptation, and Exercise adoption), treatment algorithm: PROCEED (Previous experience, Risk factors, Organ damage, Contraindications or unfavorable conditions, Expert's or doctor's judgment, Expenses or cost, and Delivery and compliance issue), and medication adjustment algorithm: AT GOALs (Adherence, Timing of administration, Greater doses, Other classes of drugs, Alternative combination or single-pill combination, and Lifestyle modification + Laboratory tests). In particular, the effort of translating the concept of central BP into clinical practice may stand out from all other hypertension guidelines. In summary, our guidelines may deliver useful information and guidance to clinicians in managing hypertensive patients, including the approach to a more accurate diagnosis, treatment and adjustment algorithm, and evidence-based recommendations.

Impact of baseline blood pressure on the magnitude of blood pressure lowering by nifedipine gastrointestinal therapeutic system: refreshing the Wilder’s principle

“…Previous studies and guidelines recommend initial combination therapy for early BP control, particularly for patients with BP above 160/100 mmHg or BP 20 mmHg above target BP. 1 – 7 The rationale for this recommendation is that any standard dose of a single agent will lower BP by 10/5 mmHg, while any combination of standard dose of two antihypertensive drugs will reduce BP by 20/10 mmHg. 8 , 9 It has been reported that BP reduction with antihypertensive drugs is directly related to the baseline BP, 10 , 11 challenging the concept of initial combined administration.…”

Type 1 (IgG4‐related) autoimmune pancreatitis: Experiences in a medical center in southern Taiwan within the past 10 years

“…The rate of DM was 28.5 % but increased to 44% among those older than 60 years, which was higher than the DM prevalence in Taiwan (approximately 20% in the population older than 60 years) [17]. The rate of hypertension (HTN) was 35.7% but increased to 55 % among those older than 60 years, which might be similar to the HTN prevalence in Taiwan (47% among individuals aged 60 years) [18]. Heart disease, renal disease and liver disease didn't show positive correlation with type 1 AIP.…”

Hypertension Guidelines: Timely New Initiatives from East Asia

“…This issue of Pulse brings together reviews of new or pending guidelines for the management of hypertension from China, Japan, Korea and Taiwan, covering the vast populations of East Asia [1,2,3,4,5,6,7,8,9]. This is a most timely and welcome initiative for many reasons.…”

“…One area of difference, compared to the recent western guidelines, is that all four of these Asian guidelines recommend more stringent blood pressure targets for some groups of patients, albeit with some variation amongst these. The Japanese guidelines recommend a retention of the target of <130/80 mm Hg for patients with diabetes or chronic kidney disease and albuminuria [3,7], and the Taiwan guidelines advocate this same target for patients with diabetes and proteinuric renal disease, and additionally for those with coronary disease and those receiving antithrombotic drugs for stroke prevention [5,9]. The Korean guidelines recommend tighter targets for high-risk patients, specifically <140/85 mm Hg for patients with diabetes and <130/80 mm Hg for those with chronic renal disease and prominent albuminuria [4,8].…”

“…In summary, these four sets of guidelines [2,3,4,5,6,7,8,9] make a very timely and substantial contribution to the management of hypertension in the vast populations of Asia that are increasingly burdened by hypertension, metabolic disorders and cardiovascular disease. The four guidelines apply to populations with great similarities in the characteristics of their hypertension and their cardiovascular disease burden.…”