Hypertension Management: Changes in Guidelines and Application in Practice


Dr Shyam Bihari Bansal, Gurugram    12 January 2018

 Patients with CKD require many antihypertensive drugs to control their BP. Treating HTN reduces the risk of cardiovascular disease outcomes. Systolic BP targets to reduce cardiovascular morbidity and mortality among persons without diabetes still remain uncertain. Similarly HTN control is most important determinant of decline of renal function in patients with CKD.

The JNC 8 states that the BP goal for all patients should be <140/90 mmHg, except for older adults where the goal is <150/90 mmHg.

According to new guidelines from the American College of Cardiology/American Heart Association (ACC/AHA), published in Hypertension and simultaneously presented at the 2017 American Heart Association Scientific Sessions held from November 11-15 in Anaheim, California. Hypertension is now defined as a BP of ≥130/80 mmHg. Previously published guidelines in 2003 categorized HTN diagnosis as a BP of ≥140/90 mmHg. These new guidelines essentially increase the proportion of adults in who have hypertension.

In addition to pharmacologic intervention for reducing BP, the 2017 ACC/AHA guidelines recommend lifestyle modifications, especially for the 9.4% of adults with HTN who are not appropriate candidates for antihypertensive medications. These alternative management strategies include weight loss, smoking cessation, moderation of alcohol consumption and increased physical activity.

A study in the Journal of the American College of Cardiology found that 45.6% of US adults have HTN under the new ACC/AHA guidelines. Using the expanded definition for HTN, the researchers theorized that a greater number of individuals will be diagnosed with high BP and will subsequently be prescribed more potent antihypertensive medications.

The investigators of the study suggested that patients are not meeting the new BP target and “a substantial (cardiovascular disease) risk reduction benefit should occur with more intensive antihypertensive medication treatment.”

Azilsartan is the latest ARB to be approved by USF DA for Hypertension. Azilsartan has proved to play an important role in reducing the need for treatment compromise in HTN patients as well as patients with comorbidities.

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