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Controversies in blood pressure goal guidelines and masked hypertension
Author(s) -
Phillips Robert A.
Publication year - 2012
Publication title -
annals of the new york academy of sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.712
H-Index - 248
eISSN - 1749-6632
pISSN - 0077-8923
DOI - 10.1111/j.1749-6632.2012.06489.x
Subject(s) - medicine , ambulatory blood pressure , thiazide , blood pressure , masked hypertension , diabetes mellitus , kidney disease , cardiology , coronary artery disease , obstructive sleep apnea , ambulatory , aldosterone , intensive care medicine , endocrinology
In uncomplicated hypertension, <140/90 mmHg is the treatment goal for individuals aged 18–79 and between 140 mmHg and 150 mmHg in those 80 years of age. Inhibitors of the renin–angiotensin–aldosterone system, as well as calcium channel blockers, are universally accepted as first‐line therapy in uncomplicated hypertension, but controversy exists over the role of thiazide diuretics and beta blockers. Because at similar blood pressure (BP) levels, African Americans have more target organ damage than whites, a lower goal of <135/85 mmHg is recommended. In patients with coronary artery disease, diabetes, and chronic kidney disease, <130/80 mmHg is recommended. Masked hypertension, defined as normal clinic BP with a high average self‐monitored or ambulatory BP, is prevalent in those with chronic kidney disease, diabetes, and obstructive sleep apnea. Masked hypertension is associated with worse outcome. Ambulatory BP monitoring for those at risk for masked hypertension needs to be incorporated into guidelines.