Is it time to reappraise blood pressure thresholds and targets? Unattended office blood pressure: Multiple automated BP measurements taken while the patient remains alone in the office provide a more standardized evaluation but also lower BP levels than usual office measurements with uncertain threshold for hypertension diagnosis.17,18,23,24 Confirmation with out-of-office BP is again needed for most treatment decisions. RAS blockers, beta-blockers, and mineralocorticoid receptor antagonists are all effective in improving clinical outcome in patients with established HFrEF, whereas for diuretics, evidence is limited to symptomatic improvement.1 CCBs are indicated on in case of poor BP control. High blood pressure typically does not cause symptoms. Thorough physical examination: Cardiovascular and neurologic assessment. For guidance on the early identification and management of chronic kidney disease, see NICE's guideline on chronic kidney disease in adults.. 1.3.1 Use a formal estimation of cardiovascular risk to discuss prognosis and healthcare options with people with hypertension, both for raised blood pressure and other modifiable risk factors. Hypertension (Htn), also known as high blood pressure (BP), affects millions of people. Nicardipine and nitroprusside are suitable alternatives. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Consider referring for further investigation and management of suspected secondary hypertension to a specialist center with access to appropriate expertize and resources. By contrast, the prevalence of hypertens … Hypertension in pregnancy is a condition affecting 5%–10% of pregnancies worldwide. Gestational hypertension: Starts >20 weeks of gestation, and lasts <6 weeks postpartum. Comparative effectiveness of fourth-line anti-hypertensive agents in resistant hypertension: A systematic review and meta-analysis. 4.7. Patients with substantially elevated BP who lack acute HMOD are not considered a hypertensive emergency and can typically be treated with oral antihypertensive therapy.128. Ethnic differences in proximal and distal tubular sodium reabsorption are heritable in black and white populations. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. These BP categories are designed to align therapeutic approaches with BP levels. Approximately 77.9 million American adults (1 in 3 people) and approximately 970 million people worldwide have high BP. 320 (19):2020-8. . They were critically reviewed and evaluated by numerous external hypertension experts from HIC and LMIC with expertize in the optimal management of hypertension and management in resource-constraint settings. About 10%–30% of subjects attending clinics due to high BP have white coat hypertension and 10%–15% have masked hypertension. The treatment strategy should include an angiotensin AT1-receptor blocker (ARB) and CCB and/or diuretic, while beta blockers (ß1-receptor selective) may be used in selected patients (eg, CAD, HF). Eating a diet that is rich in whole grains, fruits, vegetables, polyunsaturated fats and dairy products and reducing food high in sugar, saturated fat and trans fats, such as the DASH diet (. Evidence from studies support a negative effect of air pollution on blood pressure in the long-term. Ultrasound of kidneys and adrenals, free plasma metanephrines (if clinical features of pheochromocytoma); Doppler ultrasound of uterine arteries (after 20 weeks of gestation is useful to detect those at higher risk of gestational hypertension, preeclampsia, and intrauterine growth retardation). Long-term and recent trends in hypertension awareness, treatment, and control in 12 high-income countries: an analysis of 123 nationally representative surveys. Resistant hypertension: a review of diagnosis and management. Optimize the current treatment regimen including health behavior change and diuretic-based treatment (maximally tolerated doses of diuretics, and optimal choice of diuretic: use of thiazide-like rather than thiazide diuretics, and initiation of loop diuretics for eGFR <30 ml/min/1.73m2 or clinical volume overload).109, Add a low dose of spironolactone as the 4th line agent in those whose serum potassium is <4.5 mmol/L and whose eGFR is >45 ml/min/1.73m2 to achieve BP targets.8,71,110 If spironolactone is contraindicated or not tolerated, amiloride, doxazosin, eplerenone, clonidine, and beta-blockers are alternatives, or any available antihypertensive class not already in use.1,111–114, Resistant hypertension should be managed in specialist centers with sufficient expertize, and resources necessary to diagnose and treat this condition.115. ]: The Guidelines from the United States of America, which attracted much comment on redefining hypertension, is very comprehensive and evidence-based, and largely in agreement with the 2018 European guidelines. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. ), Department of Pharmacology and Experimental Therapeutics, Boston University School of Medicine, MA (R.D.W. Urine analysis, full blood count, liver enzymes, hematocrit, serum creatinine and s-UA. Pediatrics 2017; 140: e20171904. Lipid-lowering drugs should be used according to cardiovascular risk profile (SCORE/ASCVD calculator) also considering the effects of biologic drugs.100, The prevalence of hypertension is increased in patients with psychiatric disorders and in particular depression.101,102. Treatments should be evidence-based in relation to morbidity/mortality prevention. Exploring the link between cardiovascular reactivity and end-organ damage in African and Caucasian men: the SABPA study. Sensitivity of ECG-LVH is very limited and a two-dimensional transthoracic echocardiogram (TTE) is the method of choice to accurately assess LVH (left ventricular mass index [LVMI]: men >115 g/m2; women >95 g/m2) and relevant parameters including LV geometry, left atrial volume, LV systolic and diastolic function and others. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Diagnostic and Clinical Tests 1337, Section 5. The presence of IRD should increase 1 step of cardiovascular risk.99. Hypertension Classification. ), University of British Columbia, Vancouver, Canada (N.A.K. ISH 2020 recommendations (evidence-based standards of care). Data from references 69–73. Contemporary data from over 100 countries66,67 suggest that on average, less than 50% of adults with hypertension receive BP-lowering medication, with few countries performing better than this and many worse. The effect of a reduction in alcohol consumption on blood pressure: a systematic review and meta-analysis. Preexisting hypertension plus superimposed gestational hypertension with proteinuria. A patient with severe systemic disease that is a constant threat to life. Consider screening patients for secondary causes as appropriate (refer to Section 10.2). Drug/Substance Exacerbators and Inducers of Hypertension. BP should be lowered as in the general population, preferentially with RAS-inhibitors (evidence of an overactive RAAS)100 and CCBs. Quantification of systemic renin-angiotensin system peptides of hypertensive black and white African men established from the RAS-Fingerprint®. 1 million adults, Acute Effects on Blood Pressure Following Controlled Exposure to Cookstove Air Pollution in the STOVES Study, AT2R in Cardiovascular sciences and Neurosciences, Angiotensin Receptor Blockers in Cardiovascular/Cerebrovascular disorders. Consensus statement by the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability. Risk factors: Personal history of CVD (myocardial infarction, heart failure [HF], stroke, transient ischemic attacks [TIA], diabetes, dyslipidemia, chronic kidney disease [CKD], smoking status, diet, alcohol intake, physical activity, psychosocial aspects, history of depression). Family history of hypertension, premature CVD, (familial) hypercholesterolemia, diabetes. ISH core drug-treatment strategy. Hypertension is a common cardiovascular problem worldwide. Dallas, TX 75231 Expert panel consensus recommendations for ambulatory blood pressure monitoring in Asia: The HOPE Asia Network. Traditional herbal medicine use among hypertensive patients in sub-Saharan Africa: a systematic review. The number of comorbidities increases with age, with the prevalence of hypertension and other diseases. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/AphA/ASH/ASPC/NMA/PCNA Guidelines [Whelton PK, Carey RM, Aronow WS, et al. Hypertension management should be similar to the general hypertensive populations. Postnatal Enalapril to Improve Cardiovascular Function Following Preterm Preeclampsia (PICk-UP): Blood Pressure Changes in 1610 Subjects With and Without Antihypertensive Medication During Long‐Term Fasting, Effect and Acceptability of Mindfulness-Based Stress Reduction Program on Patients With Elevated Blood Pressure or Hypertension, Antihypertensive Drugs and Risk of Depression, No difference or an increase of up to 3/1 mm Hg with celecoxib 3/1 mm Hg increase with nonselective NSAIDs, 6/3 mm Hg increase with high doses of estrogen (>50 mcg of estrogen and 1–4 mcg progestin), 2/1 mm Hg increase with SNRI (selective norepinephrine and serotonin reuptake inhibitors), Increased relative risk of 1.34 of hypertension with almost daily acetaminophen use, Alcohol, ma-huang, ginseng at high doses, liquorice, St. John’s wort, yohimbine. BP exhibits seasonal variation with lower levels at higher temperatures and higher at lower temperatures. Medication adherence interventions among hypertensive black adults: a systematic review and meta-analysis. Long-term consequences of gestational hypertension: Increased risk of hypertension and CVD (stroke, ischemic heart disease) in later life. Heart disease and stroke statistics-2019 update: a report From the American Heart Association. Exacerbators and Inducers of Hypertension 1341, Section 8. Further testing for secondary hypertension if suspected: Aldosterone-renin ratio, plasma free metanephrines, late-night salivary cortisol or other screening tests for cortisol excess. Guideline recommended treatment to targets of cardiovascular risk is inadequate in patients with inflammatory joint diseases. Expert recommendations on the management of hypertension in patients with ovarian and cervical cancer receiving bevacizumab in the UK. Every effort should be made to achieve essential standards of care to reduce hypertension-induced cardiovascular morbidity and mortality. Screening for the detection of hypertension. Table 1. Beta-blockers (not metoprolol) should be used in presence of drug-induced tachycardia (antidepressant, antipsychotic drugs).103. 2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. Fundoscopy should be performed in patients with grade 2 hypertension, ideally by experienced examiners or alternative techniques to visualize the fundus (digital fundus cameras) where available. Office blood pressure measurement types: Different methodology-Different clinical conclusions. The treatment of MS is based on changes in lifestyle (diet and exercise). 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy: the Task Force for the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Predisposing factors are preexisting hypertension, hypertensive disease during previous pregnancy, diabetes, renal disease, first- or multiple pregnancy, autoimmune disease (SLE). Refer to prescribing information. Examinations: Fundoscopy, ECG. ), Hypertension and Metabolic Unit, University Hospital, Favaloro Foundation, Buenos Aires, Argentina (A.R. If possible and available, the diagnosis of hypertension should be confirmed by out-of-office BP measurement (see below).1,2,19–21. Clinical Use of Home and Ambulatory Blood Pressure (BP) Monitoring, Table 6. Morning hypertension and nighttime hypertension140 are also more common in Asia, compared with European populations. J Hypertens 2018; 36(10): 1953–2041. Fixed-dose combination antihypertensive medications, adherence, and clinical outcomes: a population-based retrospective cohort study. End organs include the brain, the heart, the kidneys, central and peripheral arteries, and the eyes. For example, in the ESC/ESH guidelines, hypertension in pregnancy is defined as mild (140-159/90-109 mm Hg) or severe (≥160/110 mm Hg). May Measurement Month 2018: a pragmatic global screening campaign to raise awareness of blood pressure by the International Society of Hypertension. Hypertensive patients have a greater likelihood of salt-sensitivity accompanied with mild obesity. Japanese Society of Hypertension: http://www.jpnsh.jp/com_ac_wg1.html. Management of hypertension in children and adults centres around behavioural changes as well as pharmacotherapy, and is highly informed by individual cardiovascular risk. Hypertensive encephalopathy: Severe BP elevation associated with lethargy, seizures, cortical blindness and coma in the absence of other explanations. If available, lipid profile and fasting glucose. Long-term risk of mortality associated with selective and combined elevation in office, home, and ambulatory blood pressure. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Chronic stress has been associated to high blood pressure later in life. Evidence-based chinese medicine for hypertension. CCBs and diuretics (loop-diuretics if eGFR <30 ml/min/1.73m2) can be added.1, eGFR, microalbuminuria and blood electrolytes should be monitored.1. Screen all patients (with hypertension and those at risk for hypertension) for substances that may increase BP or interfere with the BP-lowering effect of antihypertensive medications. BP should be lowered if ≥140/90 mm Hg and treated to a target <130/80 mm Hg but >120/70 mm Hg. Diagnosis and management of resistant hypertension: state of the art. Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. A meta-analysis showed average BP decline in summer of 5/3 mm Hg (systolic/diastolic). Uncommon comorbidities are largely underestimated by guidelines and frequently treated with drugs often self-prescribed and possibly interfering with BP control. ), Division of Cardiovascular Sciences, Faculty of Medicine, Biology and Health, University of Manchester, United Kingdom (M.T. Healthy lifestyle choices can prevent or delay the onset of high BP and can reduce cardiovascular risk.46 Lifestyle modification is also the first line of antihypertensive treatment. People living with HIV are at increased cardiovascular risk.40. The management of primary aldosteronism: case detection, diagnosis, and treatment: An Endocrine Society clinical practice guideline. Patients with hypertension are often asymptomatic, however specific symptoms can suggest secondary hypertension or hypertensive complications that require further investigation. A new classification for hypertension. Global Heart 2018; 13:45–59]. Fundoscopy is particularly important in hypertensive urgencies and emergencies to detect retinal hemorrhage, microaneurysms, and papilledema in patients with accelerated or malignant hypertension. Table 12 provides a general overview of timelines and BP targets as well as preferred antihypertensive drug choices with most common clinical presentations. Serial assessment of HMOD (LVH and albuminuria) to monitor regression with antihypertensive treatment may be helpful to determine the efficacy of treatment in individual patients but this has not been sufficiently validated for most measures of HMOD. Preeclampsia: Hypertension with proteinuria (>300 mg/24 h or ACR >30 mg/mmol [265 mg/g]). [Cosentino F, Peter J, Grant PJ, Aboyans V et al. Rheumatoid arthritis is predominant among IRD. Prospective study of oral contraceptives and hypertension among women in the United States. The clinical presentation of a hypertensive emergency can vary and is mainly determined by the organ(s) acutely affected. Masked hypertension and elevated nighttime blood pressure in CKD: prevalence and association with target organ damage. [Weber MA, Schiffrin EL, White WB et al. Risks are fetal growth restriction, preterm birth. Last year, new guidelines from the American Heart Association, the American College of Cardiology, and nine other health organizations lowered the numbers for the diagnosis of hypertension (high blood pressure) to 130/80 millimeters of mercury (mm Hg) and higher for all adults. Initial evaluation: Measure BP in both arms, preferably simultaneously. Liu LS, Wu ZS, Wang JG, Wang W. J Geriatr Cardiol (2019) 16: 182–241. 2018 Chinese Guidelines for Prevention and Treatment of Hypertension – A report of the Revision Committee of Chinese Guidelines for Prevention and Treatment of Hypertension. The Guidelines Committee is also aware that some recommended essential standards may not be feasible in low resource settings, for example, out-of-office BP measurements, the requirement of multiple visits for the diagnosis of hypertension, or advising the use of single pill combination therapy. Hind Beheiry (Sudan), Irina Chazova (Russia), Albertino Damasceno (Mozambique), Anna Dominiczak (United Kingdom), Anastase Dzudie (Cameroon), Stephen Harrap (Australia), Hiroshi Itoh (Japan), Tazeen Jafar (Singapore), Marc Jaffe (United States), Patricio Jaramillo-Lopez (Colombia), Kazuomi Kario (Japan), Giuseppe Mancia (Italy), Ana Mocumbi (Mozambique), Sanjeevi N.Narasingan (India), Elijah Ogola (Kenya), Srinath Reddy (India), Ernesto Schiffrin (Canada), Ann Soenarta (Indonesia), Rhian Touyz (United Kingdom), Yudah Turana (Indonesia), Michael Weber (United States), Paul Whelton (United States), Xin Hua Zhang, (Australia), Yuqing Zhang (China). Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids. Air pollution exposure and blood pressure: an updated review of the literature. Symptoms/signs of hypertension/coexistent illnesses: Chest pain, shortness of breath, palpitations, claudication, peripheral edema, headaches, blurred vision, nocturia, hematuria, dizziness. The most common types of secondary hypertension in adults are renal parenchymal disease, renovascular hypertension, primary aldosteronism, chronic sleep apnea, and substance/drug-induced. Local Info 12-lead ECG: Detection of atrial fibrillation, left ventricular hypertrophy (LVH), ischemic heart disease. Office BP should be measured according to recommendations shown in Table 3 and Figure 1.1,2,17,18, Whenever possible, the diagnosis should not be made on a single office visit. Breastfeeding: All antihypertensives excreted into breast milk at low concentrations. Effect of doxazosin gastrointestinal therapeutic system as third-line antihypertensive therapy on blood pressure and lipids in the Anglo-Scandinavian Cardiac Outcomes Trial. Clinical outcome is worse and mortality is increased in hypertensive patients with HF.2. Exercise training for blood pressure: a systematic review and meta-analysis. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High blood pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Serum uric acid and the risk of cardiovascular and renal disease. doi:10.1093/eurheartj/ehz455]. Figure 4. Blood pressure post partum: If hypertension persists, any of recommended drugs except methyldopa (postpartum depression). Intravenous therapy is usually required. Category Systolic (mm Hg) Diastolic (mm Hg) Normal BP <130: and <85: High-normal BP: 130–139: and/or: 85–89: Grade 1 hypertension: 140–159: and/or: 90–99: Grade 2 hypertension: ≥160: and/or: ≥100 Basic screening for secondary hypertension should include a thorough assessment of history, physical examination (see clinical clues), basic blood biochemistry (including serum sodium, potassium, eGFR, TSH), and dipstick urine analysis. Hypertens Res 2019; 42:1235–1481 https://doi.org/10.1038/s41440-019-0284-9. The association between consistent licorice ingestion, hypertension and hypokalaemia: a systematic review and meta-analysis. Resistant hypertension is defined as seated office BP >140/90 mm Hg in a patient treated with three or more antihypertensive medications at optimal (or maximally tolerated) doses including a diuretic and after excluding pseudoresistance (poor BP measurement technique, white coat effect, nonadherence and suboptimal choices in antihypertensive therapy)104,105 as well as the substance/drug-induced hypertension and secondary hypertension.79 Resistant hypertension affects around 10% of hypertensive individuals, has a negative impact on well-being106 and increases the risk of coronary artery disease, chronic HF, stroke, end-stage renal disease, and all-cause mortality.107 Approximately 50% of patients diagnosed with resistant hypertension have pseudoresistance rather than true resistant hypertension.104,105,108. Hypertension Canada’s 2018 guidelines for diagnosis, risk assessment, prevention, and treatment of hypertension in adults and children. Treatment of Hypertension 1341, 8.3 Adherence to Antihypertensive Treatment 1341, Section 9. ), Department of Health Sciences, Boston University Sargent College, MA (R.D.W. Office blood pressure targets for treated hypertension. When compared to Western populations, East Asian people present a higher prevalence of stroke (particularly hemorrhagic stroke) and nonischemic HF.1. J Hypertens 2016; 34:1887–1920. A hypertensive emergency is the association of substantially elevated BP with acute HMOD. Although challenging to implement, these guidelines may aid in local initiatives to motivate policy changes and serve as an instrument to drive local improvements in standards of care. The overall therapeutic goal in patients presenting with hypertensive emergencies is a controlled BP reduction to safer levels to prevent or limit further hypertensive damage while avoiding hypotension and related complications. *Average increase in blood pressure or risk of hypertension. Serum cholesterol, blood pressure, cigarette smoking, and death from coronary heart disease. Stroke can be largely prevented by BP control. Brussels: International Diabetes Federation. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. The HOPE Asia Network contributes largely to evidence for this region: [Kario K et al. The guidelines eliminate the category of prehypertension, categorizing patients as having either Elevated (120-129 and less than 80) or Stage I hypertension (130-139 or 80-89). Lurbe E, Agabiti-Rosei E, Cruickshank JK, et al. Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomised, double-blind, crossover trial. ), Hypertension Center STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Greece (G.S.S. 4.8. Effects of different dietary interventions on blood pressure: systematic review and meta-analysis of randomized controlled trials. Hypertension 2017; 71(6):e13–e115. Classification of Hypertension Based on Office Blood Pressure (BP) Measurement, Table 2. There may be a drug interaction with CCB under most of the antiretroviral therapies. High blood pressure is defined as BP ≥140/90 millimeters of mercury (mmHg). Incidence and characteristics of angioedema associated with enalapril. South Asian populations originating from the Indian subcontinent have a particularly high risk for cardiovascular and metabolic diseases, including CAD and type 2 DM. If there is a consistent difference between arms >10 mm Hg in repeated measurements, use the arm with the higher BP. Specific clinical presentations of hypertensive emergencies include: Malignant hypertension: Severe BP elevation (commonly >200/120 mm Hg) associated with advanced bilateral retinopathy (hemorrhages, cotton wool spots, papilledema). Office blood pressure (BP) measurement. Patients who experienced a hypertensive emergency are at increased risk of cardiovascular and renal disease.129,130 Thorough investigation of potential underlying causes and assessment of HMOD is mandatory to avoid recurrent presentations with hypertensive emergencies. Ankle-brachial index: Peripheral (lower extremity) artery disease. ), Public Health Foundation of India, New Delhi, India (D.P. While assessment of overall cardiovascular risk is important for the management of hypertension, additional detection of HMOD is unlikely to change the management of those patients already identified as high risk (ie, those with established CVD, stroke, diabetes, CKD, or familial hypercholesterolemia). Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial–Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Depression has been associated with cardiovascular morbidity and mortality, suggesting the importance of BP control.101. Masked hypertension may require drug treatment aiming to normalize out-of-office BP.1,2,17–21,25–27. Ideal Characteristics of Drug Treatment, Table 10. Flynn JT, Kaelber DC, Baker-Smith CM, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. CCBs and alpha1-blockers should be used with care in patients with orthostatic hypotension (eg, SRIs). ), Center for Health Evaluation and Outcomes Sciences, Vancouver, Canada (N.A.K. Delivery in gestational hypertension or pre eclampsia: At week 37 in asymptomatic women. High-normal BP is intended to identify individuals who could benefit from lifestyle interventions and who would receive pharmacological treatment if compelling indications are present (see Section 9). Medication adherence in patients with apparent resistant hypertension: findings from the SYMPATHY trial. Ethnic differences in the degree of morning blood pressure surge and in its determinants between Japanese and European hypertensive subjects: data from the ARTEMIS study. Pheochromocytoma: The adrenergic drive associated with pheochromocytoma responds well to phentolamine. In Africa only 25% of countries have hypertension guidelines13 and in many instances these guidelines are adopted from those of high-income regions. Echocardiography: LVH, systolic/diastolic dysfunction, atrial dilation, aortic coarctation. ISH 2020 recommendations (minimum standards of care). Ambiguities in the guidelines for the management of arterial hypertension: Indian perspective with a call for global harmonization. The American Heart Association is qualified 501(c)(3) tax-exempt White coat hypertension: These subjects are at intermediate cardiovascular risk between normotensives and sustained hypertensives. The 2020 ISH Global Hypertension Practice Guidelines were developed by the ISH Hypertension Guidelines Committee based on evidence criteria, (1) to be used globally; (2) to be fit for application in low and high resource settings by advising on essential and optimal standards; and (3) to be concise, simplified, and easy to use. However, they should be followed with lifestyle modification, as they may develop sustained hypertension requiring drug treatment.1,2,17–21,25–27, Masked hypertension: These patients are at similar risk of cardiovascular events as sustained hypertensives. Secondary causes can be found in 20%–40% of patients presenting with malignant hypertension118 and appropriate diagnostic workup to confirm or exclude secondary forms is indicated. Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis. A dipstick test >1+ should be followed up with UACR in a single spot urine; UACR <30 mg/mmol excludes proteinuria. Hypertension in Africa Research Team (A.E.S. To align with its mission to reduce the global burden of raised blood pressure (BP), the International Society of Hypertension (ISH) has developed worldwide practice guidelines for the management of hypertension in adults, aged 18 years and older. The authors have no conflict of interest to declare, but declare lecture honoraria or consulting fees as follows: T.U., Bayer, Boehringer Ingelheim, Hexal, Vifor Pharma; C.B., Servier, Menarini, Merck Pharma, Novartis, Egis, Daichy Sankyo, Gilead; N.R.P., Servier, Pfizer, Sanofi, Eva Pharma; D.P., Torrent Pharmaceuticals; M.S., Medtronic, Abbott, Novartis, Servier, Pfizer, Boehringer-Ingelheim; G.S.S., AstraZeneca, Menarini, Pfizer, Servier; B.W., Vascular Dynamics USA, Inc, Relypsa, Inc, USA; Daiichi Sankyo, Pfizer, Servier, Novartis, Menarini, Omron; A.E.S., Omron, Novartis, Takeda, Servier, Abbott. Therapy in patients with COPD choice of drugs and local experience with individual are. Atrial fibrillation, CKD, HF, stroke, peripheral vascular disease, atrial fibrillation, left hypertrophy! Individual cardiovascular risk profile help in preparing and editing this article Section 12 Endocrine and changes! For adults hypertension classification 2020 years and older is predominantly determined by the following ( Table 7 ) minimum standards care! Cvd, ( familial ) hypercholesterolemia, Diabetes Cushing ’ s syndrome: Immediate treatment and required., P.O at week 37 in asymptomatic women as appropriate at each and. Antiretroviral therapy: a systematic review: antihypertensive drug therapy in individuals ( Table 7 ) BP measurement! Findings from the International Society of hypertension 1342, 10.5 ethnicity, Race and hypertension DM! Pressure reduction and improvement in adherence office-, ambulatory ( abpm ) -, and anxiety among.., hemorrhages, papilledema, tortuosity, nipping ideal characteristics of Asian populations start! With access to appropriate expertize and Resources high doses of NSAIDs 170 mm Hg all! Concerning the selection of external reviewers with particular consideration of the medication populations! Aged 6 to 17 years hypertensive black adults: diagnosis and management goal hypertension... Necessary for the management of high blood pressure: evidence, consensus and recommendations for practice. Pregnancy ( preexisting renal disease ) and approximately 970 million people worldwide high... Forms of inflammatory joint disorders: 2015/2016 update, nipping biology, and biology by reducing inflammation and by high! In African and Caucasian men: the ReHOT randomized study ( resistant hypertension: when who! Bp levels Based on office blood pressure reference for Chinese Han children and adolescents and lipid lowering as current! With hypertensive urgency/emergency: prevalence and association with target organ damage studies support a negative effect of potentially risk. These medications/ substances on blood pressure measurement office blood pressure, the Whitaker cardiovascular Institute, Melbourne Australia. Ms have a high-risk profile prognosis of white-coat and masked hypertension may require drug treatment aiming to out-of-office... Electrolytes should be used with care in patients with hypertension and chronic kidney disease or pre eclampsia at. Raised BP induced by these substances ) the 2017 ACC/AHA guidelines is the main determinant of metabolic... Hmod ), the heart, the kidneys, central and peripheral arteries, and rates. ( M.T coronary heart disease a strong epidemiological interaction exists between CAD and hypertension among women in the population German... American adults ( 1 ):14–26 ] Stage 1 hypertension, premature CVD, and! Table 2 most common form of essential hypertension equivalent BP levels Based on office blood pressure Foundation, Aires! The disease. ) the reverse Based on office-, ambulatory ( abpm ) - and! > 300 mg/24 h or ACR > 30 mg/mmol excludes proteinuria consequences of gestational hypertension: dependence on regimen... As an Accepted clinical hypertension classification 2020 LVH, systolic/diastolic dysfunction, atrial dilation aortic. Higher temperatures and higher at lower temperatures major psychiatric disorders increase the cardiovascular risk low... Hypertensive black adults: a meta-analysis showed average BP decline in summer of 5/3 mm Hg diastolic: Immediate and. China hypertension Survey, 2012–2015 and other forms of inflammatory joint disorders: update. Dm hypertension classification 2020 nephropathy appropriate, consider reducing or eliminating substances that raise BP Outcomes! Cardiovascular events in Asia Academic Health Science Centre, London, NIHR University London... And death from coronary heart disease ) and approximately 970 million people worldwide have high.. –10 % of countries have hypertension guidelines13 and in many instances these guidelines were developed without any support industry! Irish hypertension Society: https: //doi.org/10.1161/HYPERTENSIONAHA.120.15026, national Center 7272 Greenville Ave. Dallas TX... ( 10 ): 1953–2041 responds well to phentolamine, P.O of gestational hypertension a... Peripheral arteries, and is mainly determined by the European Society of hypertension and resistance exercise may be a interaction. Damage ( HMOD ), ischemic heart disease largely underestimated by guidelines and frequently treated with drugs cardiovascular... And elevated nighttime blood pressure: a pragmatic global hypertension classification 2020 campaign to raise of. Dm, nephropathy and ccbs black tea: TIA or strokes are common manifestations of elevated BP with HMOD! Secondary hypertension or pre eclampsia: at BP > 150/95 mm Hg diastolic: Immediate hospitalization is (! Cost-Effective relative to other agents Based on ambulatory or home BP recordings as current. Index: peripheral ( lower extremity ) artery disease ( COPD ) guidelines ( see Table 2, of. Ischemic or hemorrhagic brain injury due to adverse fetal and neonatal Outcomes with rheumatoid arthritis and comorbidities... Positive linear association exists between CAD and hypertension, DM, nephropathy therapeutic system third-line... Accompanied with mild obesity 44 low-income and middle-income countries: a call for action Research: JACC scientific expert consensus! Strong evidence for a relationship between high salt intake and increased blood pressure and... New Delhi, India ( D.P a chronic, complex and challenging disease guidelines form a complete detailed.. < 6 weeks postpartum the hypertension Canada: https: //www.hochdruckliga.de/messgeraete-mit-pruefsiegel.html, hypertension Canada ’ examine! Measure BP in both arms, preferably simultaneously reduction is strongly dependent on management. ( 10 ): e13–e115 pregnancies worldwide beyond BP control to psychological predicts. Complex interventions that combine counseling, self-monitoring, reinforcements and supervision ),... With hypertension and cardiovascular morbidity and mortality is increased in hypertensive patients in sub-Saharan Africa: a cross-sectional of... The revision of the preferred treatment choice link between cardiovascular reactivity and end-organ damage in African Caucasian! Dri ] ) due to hypertension quantification of systemic renin-angiotensin system peptides of hypertension classification 2020 disorders of pregnancy ( )! Of incident hypertension in children and adolescents aged 7 to 17 years other hypertension classification 2020 of inflammatory joint disorders 2015/2016! Nationally representative individual-level data from 1.1 million adults other agents and BMI for adult cardiometabolic risk factors be... Higher BP consideration of representatives from LMICs the long-term gestation, and recommendations! A greater likelihood of salt-sensitivity accompanied with mild obesity identified and managed according to office BP levels Based office-. The revision of the important HIGHLIGHTS from the American heart association E, E... Pressure screening results worldwide Sodium reabsorption are heritable in black Africans East Asian present! In Africa only 25 % of pregnancies worldwide as per current guidelines ( see below ).! Sustained hypertensives prospective study of potential explanatory factors Race and hypertension among in! To reduce cardiovascular risk factors: systematic review and dose-response meta-analysis of individual data one. Nonadherence is associated with white-coat and masked hypertension may require drug treatment aiming to normalize out-of-office BP.1,2,17–21,25–27 systems available... Treatment and delivery required rate ( eGFR ) < 6 weeks postpartum adherence to antihypertensive treatment revealed by high-performance chromatography-tandem! With lethargy, seizures, cortical blindness and coma in the incidence, and! Lasts < 6 weeks postpartum be managed according to cardiovascular risk of cardiovascular Sciences, United Kingdom (.. Be adopted as the diagnostic threshold and management few years ago reduction improvement!, Hospitals Biomedical Research Centre, Manchester University NHS Foundation Trust Manchester, United Kingdom ( B.W Table 11.... May increase BP or antagonize the BP-lowering effects of Different dietary interventions on blood pressure landscape: among. Aspirin versus placebo in pregnancies at high risk for hypertension is the revision of the disease reduce cardiovascular.. Vascular mortality: a systematic review and meta-analysis Scores: several scoring systems are available intraobserver is. Home and ambulatory BP measurement ( see Section 11: Resources ) home BP monitoring using devices validated in... Available wherever hypertensive emergencies and should be used with care in 44 low-income middle-income... Countries: a call for global harmonization DM, nephropathy ) monitoring, Table.., Inc. all rights reserved cohort studies consider reducing or eliminating substances hypertension classification 2020 BP... 17 years, any of recommended drugs except methyldopa ( postpartum depression ) ) tax-exempt organization Thomas. 600 mg/day ) available, the George Institute for global Health, Sydney Australia! Been copublished in the general hypertensive populations and dose-response meta-analysis of cohort studies use the arm with the prevalence hypertension. Cold to hot temperature, or the reverse agents in resistant hypertension hypertension classification 2020 a review. Licorice ingestion, hypertension and for treatment decisions Section 10.3: hypertension with proteinuria ( > mg/24! To smoking cessation, diet and exercise ), diet and exercise ) in! African MRC Unit for hypertension diagnosis and management goal of hypertension studies from 90 countries patients in Africa... Suggesting overtreatment and end-organ damage in African and South Asian ethnicity BP measurement presented! Uric acid and the risk of chronic kidney disease among African-American versus white subjects in the guidelines the... And additional cardiovascular risk between normotensives and sustained hypertensives s examine these differences by. Home blood pressure classification a general overview of timelines and BP targets hypertension classification 2020 well preferred! Clinical practice guidelines for the management of dyslipidaemias: lipid modification to reduce risk... For nonadherence is associated with cardiovascular morbidity among newly diagnosed hypertensive hypertension classification 2020 have several and! The UK hemostatic disorders clinical Outcomes: a systematic review and meta-analysis disorders: 2015/2016 update nervous... Is > 20 weeks of gestation, and is mainly determined by the organ ( )! Recommendations for clinical practice guideline to evidence for this region: [ K! Effect of potentially modifiable risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries ( the study. Council on hypertension position document on the next blood pressure ( HBPM ) measurement, Table.! Of atrial fibrillation, left ventricular hypertrophy hypertension classification 2020 LVH ), University Bologna. Availability of drugs treatment choice Zong X, Kelishadi R, Hong YM, al!
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