To provide updated, evidence-based recommendations for the diagnosis and assessment of adults with hypertension.
The diagnosis of hypertension is dependent on appropriate blood pressure measurement, the timely assessment of serially elevated readings, degree of blood pressure elevation, method of measurement (office, ambulatory, home) and associated comorbidities. The presence of cardiovascular risk factors and target organ damage should be ascertained to assess global cardiovascular risk and determine the urgency, intensity and type of treatment required.
MEDLINE searches were conducted from November 2006 to October 2007 with the aid of a medical librarian. Reference lists were scanned, experts were contacted, and the personal files of authors and subgroup members were used to identify additional studies. Content and methodological experts assessed studies using prespecified, standardized evidence-based algorithms. Recommendations were based on evidence from peer-reviewed, full-text articles only.
Recommendations for blood pressure measurement, criteria for hypertension diagnosis and follow-up, assessment of global cardiovascular risk, diagnostic testing, diagnosis of renovascular and endocrine causes of hypertension, home and ambulatory monitoring, and the use of echocardiography in hypertensive individuals are outlined. Key messages in 2008 include continued emphasis on the expedited, accurate diagnosis of hypertension, the importance of global risk assessment and the need for ongoing monitoring of hypertensive patients to identify incident type 2 diabetes.
All recommendations were graded according to strength of the evidence and voted on by the 57 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported here received at least 70% consensus. These guidelines will continue to be updated annually.
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The measurement of central blood pressure has generated interest as a tool in predicting cardiovascular events. The purpose of this article is to review the meaning and measurement of the central blood pressure and consider its potential value as an index of the antihypertensive response. Indirect estimation of central aortic pressures is obtained by the study of the radial pulse wave compared with a central pulse wave contour measured at the carotid or femoral artery level. The sum of the forward pressure wave created by ventricular contraction and of the reflected pressure wave from the peripheral arterial system produce the peak systolic blood pressure in the aorta. Measurement of the peripheral reflected-wave contribution to aortic blood pressure can be quantified as the augmentation index. Also, the increase in the rapidity of this travelling wave can be measured as the pulse wave velocity. These 2 parameters are considered to be valid indices of the peripheral arterial stiffness. Along with the calculation of systolic and diastolic aortic pressures, these measurements can give a better understanding of the actual central blood pressure to which core organs like heart, brain, and kidneys are submitted. There is tantalizing evidence for the potential value of central blood pressure as a useful index of antihypertensive action, but until clear evidence is obtained, its use should continue to be considered exploratory.
AdADOSE was a 12-week, international, observational study conducted in the Middle East and Russia where patients received nifedipine gastrointestinal therapeutic system (GITS) at a daily dose of 30, 60, or 90?mg as part of an antihypertensive combination therapy. This subgroup analysis of the AdADOSE study assesses the efficacy and tolerability of nifedipine GITS combination therapy when used specifically at the 60-mg strength.
Patients with hypertension who received a daily nifedipine GITS dose of 60?mg, either at constant dose (n?=?686) or up-titrated from 30?mg (n?=?392), were analyzed. Target blood pressure (BP) was
Randomized double blind longitudinal study was performed from December 1, 2012 to June 15, 2013 in urological ward of gerontological hospital (Vladivostok city, Russian Federation). 378 men and women over 65 (average age: 69.8 (7.2)), who suffered from stage 1 (initial) hypertension, had participated in this study. During the treatment all patients, except for those who were assigned to the control group, received Loop Diuretic Furosemide dosed at 20-30 mg per day and Solifenacin dosed at 5 mg per day (First comparison group) and 10 mg per day (Second comparison group). Functional performance of lower urinary tract (LUT) at enrollment and at the end of the treatment was evaluated using ICIQ-SF questionnaires. During the whole period of treatment patients were keeping bladder diaries where records on frequency and volume of daily urinations, episodes of urgency (EU), episodes of incontinence (EI) and other symptoms were kept.
Comparison of data obtained from control group (7.2%), group of the patients treated with Furosemide and standard- dosed (11.1%) and low-dosed (16.2%) Solifenacin allows to draw conclusion on the absence of significant differences in number of patients with symptoms of OAB between these groups (p = 0.05). At the same time percentage of patients with symptoms of OAB in the group treated only with Furosemide was significantly different from three other groups (p = 0.05) and reached 46.1%.
Risk of developing symptoms of OAB in elderly patients, whose hypertensive disease has been treated with loop diuretic for a long period of time, decreases significantly, provided antimuscarinic drug Solifencin is administered at the same time. Administration of low dosed Solifenacin is sufficient for significant decrease in risk of developing symptoms of overactive bladder.
Fixed-dose combinations (FDCs) of antihypertensive agents improve therapeutic efficacy, according to current guidelines and large clinical studies.
This Russian study examined the effect on blood pressure (BP) of substituting current ineffective antihypertensive treatment with FDC perindopril/amlodipine in patients with uncontrolled hypertension.
BP was measured in the doctor's office at each visit, daily at home, and by ambulatory monitoring (ABPM) at inclusion and end-of-study.
Ninety patients (52.7 ± 12.2 years old; mean baseline BP 161.4/94.9 mmHg) at high or very high cardiovascular risk were included. FDC perindopril/amlodipine (5/5, 10/5 or 10/10 mg) exerted a rapid (2 weeks) and significant (p
Comment In: High Blood Press Cardiovasc Prev. 2015 Dec;22(4):427-826359089
To study efficacy and safety of a new dose and dosage form of proxodolol--a beta-adrenoblocker with alpha1-adrenoblocking activity--in patients with moderate arterial hypertension (AH).
A total of 60 patients with verified diagnosis of essential AH of the second degree were randomized into two groups: group 1 (n=40) received proxodolol, group 2 (n=20) was given carvedilol. The trial lasted for 89 days.
The trial demonstrates that proxodolol is highly effective and safe in the treatment of AH.
Proxodolol is effective and safe in hypertension, in a dose 120 mg its activity is the same as carvedilol in a dose 25 mg.
Most patients with antihypertensive medication do not achieve their blood pressure (BP) target. The most important factor behind this failure is poor medication adherence. However, non-adherence to therapy does not concern only patients. Clinicians also tend to lack adherence to hypertension guidelines, overestimate BP control and be satisfied with inadequate BP control. The aim of this non-blinded, cluster-randomised, controlled study was to investigate if using a checklist would improve the quality of care in the initiation of new antihypertensive medication and help reduce non-adherence.
The study was conducted in eight primary care study centres in Central Finland, randomised to function as either intervention (n?=?4) or control sites (n?=?4). We included patients aged 30-75?years who were prescribed antihypertensive medication for the first time. Initiation of medication in the intervention group was carried out with a 9-item checklist, filled in together by the treating physician and the patient. Hypertension treatment in the control group was managed by the treating physician without a study-specific protocol.
In total, 119 patients were included in the study, of which 118 were included in the analysis (n?=?59 in the control group, n?=?59 in the intervention group). When initiating antihypertensive medication, an adequate BP target was set for 19% of the patients in the control group and for 68% in the intervention group. Shortly after the appointment, only 14% of the patients in the control group were able to remember the adequate BP target, compared with 32% in the intervention group. The use of the checklist was also related to more regular agreement on the next follow-up appointment (64% in the control group versus 95% in the intervention group). No adverse events or side effects were related to the intervention.
Even highly motivated new hypertensive patients in Finnish primary care have significant gaps in their informational and behavioural skills. The use of a checklist for initiation of antihypertensive medication was related to significant improvement in these skills. Based on our findings, the use of a checklist might be a practical tool for addressing this problem.
NCT02377960 . Date of registration: February 26th, 2015.
The implementation of lifestyle modifications, home blood pressure (BP) measurement, and optimization of antihypertensive drug therapy have been shown to improve BP control in tightly controlled research settings. Our objective was to determine the effect of these interventions in a primary care setting, with the family practitioners and nurses serving as the interventionists.
Two hundred twenty hypertensive patients were recruited from 2 health centers that operated in the same building and covered similar populations, with the health centers randomized to function as intervention or control sites. Participants in the intervention group received repeated individual and group counseling from the centrally trained staff of the health center on healthy lifestyles. In addition, their antihypertensive drug therapy was guided by home BP measurements performed at 3-month intervals instead of by conventional office measurements.
After 12 months of follow-up, the between-group differences in the changes of lifestyle variables (body mass index, physical activity, dietary recalls, and urinary sodium/potassium) were nonsignificant. Antihypertensive treatment intensity increased in both groups, but the between-group difference was nonsignificant (P = 0.63). Office systolic/diastolic BP decreased significantly in the intervention (8/6 mm Hg; P
Comment In: Am J Hypertens. 2014 Mar;27(3):291-324363277
Many guidelines suggest that angiotensin-converting enzyme inhibitors and angiotensin-II receptor antagonists (collectively referred to as renin, angiotensin, aldosterone system blockers (RAAS blockers)) are the preferred treatment for hypertension in most patients with chronic kidney disease (CKD). Improving the recognition of CKD with the introduction of eGFR reporting was intended to have more patients recognized with and treated for this disease. To quantify this, we examined trends in RAAS-blocker use over an 88-month period before and after routine eGFR reporting in southwestern Ontario, Canada. An intervention analysis with seasonal time-series modeling on linked health administrative data for 45,361 ambulatory residents with CKD (eGFR stages 3-5) older than 65 years was performed with a primary outcome of RAAS-blocker usage. The reporting of eGFR was associated with a significant increase in the use of RAAS blockers, as the prescription rate was 571 per 1000 patients with CKD prior to reporting but improved to 607 per 1000 after reporting. There was a significant increase in RAAS-blocker use attributable to eGFR reporting of 19 per 1000 CKD patients. Since about 8% of the adult population has CKD, this equates to about 15,200 new patients receiving RAAS-blocker treatment by 1 year after the introduction of eGFR reporting in community laboratories. Thus, eGFR reporting contributes to improved, guideline-appropriate care of older patients with CKD.
AIM: To compare the accuracy of clinic blood pressure (CBP) and telemedical home blood pressure (HBP) measurement in the assessment of antihypertensive effect. METHODS: 362 patients on antihypertensive medication performed HBP measurement (5 days, duplicate measurements, four times daily) and ambulatory blood pressure (ABP) monitoring in random order. Main outcome measure was the agreement of CBP and HBP with daytime ABP. RESULTS: CBP was much higher than ABP and average HBP (p