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Guideline for the diagnosis and management of hypertension in adults — 2016
Author(s) -
Gabb Genevieve M,
Mangoni Arduino A,
Anderson Craig S,
Cowley Diane,
Dowden John S,
Golledge Jonathan,
Hankey Graeme J,
Howes Faline S,
Leckie Les,
Perkovic Vlado,
Schlaich Markus,
Zwar Nicholas A,
Medley Tanya L,
Arnolda Leonard
Publication year - 2016
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/mja16.00526
Subject(s) - medicine , blood pressure , guideline , ambulatory blood pressure , cardiology , stroke (engine) , intensive care medicine , disease , kidney disease , prehypertension , emergency medicine , mechanical engineering , pathology , engineering
Summary The National Heart Foundation of Australia has updated the Guide to management of hypertension 2008: assessing and managing raised blood pressure in adults (updated December 2010). Main recommendationsFor patients at low absolute cardiovascular disease risk with persistent blood pressure (BP) ≥ 160/100 mmHg, start antihypertensive therapy. The decision to treat at lower BP levels should consider absolute cardiovascular disease risk and/or evidence of end‐organ damage, together with accurate BP assessment. For patients at moderate absolute cardiovascular disease risk with persistent systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg, start antihypertensive therapy. Treat patients with uncomplicated hypertension to a target BP of < 140/90 mmHg or lower if tolerated.Changes in management as a result of the guidelineAmbulatory and/or home BP monitoring should be offered if clinic BP is ≥ 140/90 mmHg, as out‐of‐clinic BP is a stronger predictor of outcome. In selected high cardiovascular risk populations, aiming for a target of < 120 mmHg systolic can improve cardiovascular outcomes. If targeting < 120 mmHg, close follow‐up is recommended to identify treatment‐related adverse effects including hypotension, syncope, electrolyte abnormalities and acute kidney injury.Why the changes have been madeA 2015 meta‐analysis of patients with uncomplicated mild hypertension (systolic BP range, 140–159 mmHg) demonstrated that BP‐lowering therapy is beneficial (reduced stroke, cardiovascular death and all‐cause mortality). A 2015 trial comparing lower with higher blood pressure targets in selected high cardiovascular risk populations found improved cardiovascular outcomes and reduced mortality, with an increase in some treatment‐related adverse events.