For the past 25 years, guidelines for the treatment of high blood pressure have recommended a stepped. Historically, initial treatment of hypertension with combination therapy has been discouraged because of concern about excessive reduction in bp, increased side effects and the dif. Choice of initial therapy for hypertension jama jama network. Results in patients with diastolic blood pressures averaging 115 through 129 mm hg. The risk of cardiovascular morbidity and mortality is directly. Approximately 30% or more of all american adults have hypertension and unfortunately, many do not know they have the disease.
B c orthostatic measurement of blood pressure should be performed during initial evaluation of hypertension and. Verapamil was equally effective in blacks and whites, whereas propranolol was more effective in whites. A 48 year old male with a two year history of hypertension. Initial treatment of hypertension nejm resident 360. No endorsement is implied or intended by the american medical association of any thirdparty organization, product, drug or service. However, the us joint national committee guideline 8 jnc8 guidelines have listed that a twodrug initial treat. Even worse are the facts that a many people who have high blood pressure do know they have the disease but do not seek treatment they ignore the. Initial treatment of hypertension the 2017 accaha hypertension guideline redefines hypertension as a systolic blood pressure of mm hg or more or a diastolic blood pressure of 80 mm hg or more and lowers the bloodpressure target to less than 80 mm hg. Combination therapy is superior to sequential monotherapy for. Jnc 8 hypertension guideline algorithm initial drugs of.
May 14, 2019 hypertension is the most prevalent risk factor for stroke, based on data from 30 studies, and has been reported in about 64% of patients with stroke. Firstline pharmacologic treatment of hypertension for nonblack patients includes thiazide diuretics. Hypertension is a major health problem throughout the world because of its high prevalence and its association with increased risk of cardiovascular disease. Ideal bp control is even more imperative when comorbidities e. Initial combination therapy is recommended if bp is greater than 2010mm hg above goal at blood pressure goal. Although in recent years hypertension has been defined as a blood pressure of 14090 mm hg or more, the 2017 american college of cardiologyamerican heart association accaha hypertension guideline adopted a lower threshold, in which hypertension is defined as a systolic blood pressure of mm hg or more or a. Initial treatment of hypertension new england journal. Ambulatory blood pressure measurements predict cardiovascular events more. Initial management of hypertension uses a twopronged approach, with emphasis on lifestyle measures and addon drug management. Quarterdose quadruple combination therapy for initial. Health care guideline diagnosis and initial treatment of ischemic stroke icsi has endorsed with qualifications the following american heart association ahaamerican stroke association asa documents. Hypertension, or high blood pressure, is dangerous because it can lead to strokes, heart attacks, heart failure, or kidney disease.
Health oaching sessions to ommunity health hubs one clinical followup visit if client has stage 2 hypertension p 14090 from her initial screening visit. B c all hypertensive patientswith diabetes should have home blood pressure monitored to identify whitecoat hypertension. Hypertension 116, 4664, or high blood pressure, is a very common and serious condition that can lead to or complicate many health problems. A practical guide informed by the hypertension canada. Initial treatment of all patients should include lifestyle mod ifications designed to lower blood pressure. May 17, 2018 download fulltext pdf initial treatment of hypertension article pdf available in new england journal of medicine 37820. Henry black talks about a recent study that compares monotherapy, freedose combination, and fixeddose combination in reaching goal in patients with early hypertension. During the study period, an increasing proportion of patients were treated initially with combination rather than with singleagent therapy 20. Optima nct02968901 was a prospective, multicenter, singlearm, openlabel, phase iv trial evaluating the efficacy, safety and tolerability of initial oral combination therapy with macitentan and tadalafil in patients with newly. High blood pressure hypertension diagnosis and treatment. The functional medicine approach three different cases three different causes hypertension allopathic disease. Initial drug therapy may be with any drug class currently indicated for the treatment of hypertension. Intravenous antihypertensive drugs for treatment of hypertensive emergencies 1 of 2 27.
Hypertension is the most prevalent risk factor for stroke, based on data from 30 studies, and has been reported in about 64% of patients with stroke. Pdf a 50yearold black man has a blood pressure of 160110 mm hg on repeated measurements. Common questions about the initial management of hypertension. Key clinical points initial treatment of hypertension the 2017 accaha hypertension guideline redefines hypertension as a systolic blood pressure of mm hg or more or a diastolic blood. Combination therapy as initial treatment for newly. Risk assessment, prevention, and treatment of hypertension. Expanding role for combination drug therapy in the initial. Evidencebased treatment protocols world health organization. Hypertension medication treatment protocol1 this document is not intended as a substitute for the medical advice of a physician. Both the seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure and the european society of hypertension have recommended initiating antihypertensive therapy with a single agent in patients with stage 1 or grade 1 hypertension systolic initial drug treatment of hypertension in patients who do not have concomitant illness. Based on the seventh report of the joint national committee of prevention, detection, evaluation, and treatment of high blood pressure jnc 7 and the 2010 institute for clinical systems improvement icsi guideline on the diagnosis and treatment of hypertension recommendations, thiazide diuretics were the preferred initial agents in the. Open access protocol monotherapy versus dual therapy for. Protocol case 2 a 57 year old male with a three year history of hypertension.
Thiazides might be the best initial treatment for hypertension. If hypertension is not diagnosed but there is evidence of target organ damage, consider carrying out investigations for alternative causes of the target organ damage for information on investigations, see nices guidelines on chronic kidney disease in adults and chronic heart failure. Between 2002 and 2007, a total of 161,585 patients met criteria for incident hypertension and were initiated on treatment. Assess the patient for hypertension using the bp measure at initial visit and repeated measurements taken at home or at office visits. Alphaadrenergic blockers should be used with caution in the treatment of hypertension. He is 9 kg 20 lb overweight, has a family history of. Open access protocol monotherapy versus dual therapy for the. The risk of cardiovascular morbidity and mortality is.
Pdf initial treatment of hypertension researchgate. If patient is hypotensive when standing but has mild hypertension. Health care guideline diagnosis and initial treatment of. Detailed summary from the 2017 guideline for the prevention. Rationale for combination therapy as initial treatment for. Blood pressure components, risk, and comorbidities of hypertension 10. Combination therapy is superior to sequential monotherapy. Pdf on may 17, 2018, indranill basuray and others published initial treatment of hypertension find, read and cite all the research you. Blood pressure goal for patients with hypertension 5. What drug classes are recommended for the initial management of hypertension. Appropriate treatment of hypertension is a necessary element of good medical practice.
The goal of hypertension treatment is to lower high blood. Coexistence of hypertension and related chronic conditions 11. Download fulltext pdf initial treatment of hypertension article pdf available in new england journal of medicine 37820. Another intervention that initially seemed to hold great promise for the treatment of resistant hypertension is renal artery denervation. Nonpharmacological therapy or lifestyle management has an important role in both nonhypertensive and hypertensive individuals. Although in recent years hypertension has been defined as a blood pressure of 14090 mm hg or more, the 2017 american college of cardiologyamerican heart association accaha hypertension guideline adopted a lower threshold, in which hypertension is defined as a systolic blood pressure of. Ahaasa guidelines for the early management of patients with acute ischemic stroke 20. Both the seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure and the european society of hypertension have recommended initiating antihypertensive therapy with a single agent in patients with stage 1 or grade 1 hypertension systolic adults. Stage 1 hypertension at diagnosis consider at or before 6 months of lifestyle modifications if bp goals unmet stage 2 hypertension at diagnosis at diagnosis 1 for frail elderly patients, standing blood pressure measurements should be considered before initiating drug treatment. Patients with hypertension systolic blood pressure. In african american adults with hypertension but without hf or ckd, including those with dm, initial antihypertensive treatment should include a thiazidetype diuretic or ccb.
N2 a 56yearold woman presents for elevated blood pressure, which was noted at a jobsite screening. In patients beginning hypertension monotherapy, diuretics are a more effective and safer option than angiotensinconverting enzyme ace inhibitors, according to a large, retrospective, industryfunded analysis in the lancet using nine healthcare databases from the u. Initial combination therapy for treatment of hypertension. Two or more antihypertensive medications are recommended to achieve a bp target of hypertension is one of the most common health problems in the world. The british hypertension society research network took a lead role in the design of accelerate aliskiren and the calcium channel blocker amlodipine combination as an initial treatment strategy for hypertension control, 9 a previous trial addressing questions similar to those in pathway. How would you further evaluate and treat this patient. Treatment monitoring during the drug titration phase patients should be seen every 2 to 4 weeks to adjust the treatment. More severe hypertension, stage 2 hypertension is a systolic pressure of 140 mm hg or higher or a diastolic pressure of 90 mm hg or higher. Lancet 2019 oct 24 but median followup was only about 2 years in this large retrospective study. Quarterdose quadruple combination therapy for initial treatment of hypertension. Clinical guidelines for the management of hypertensionedited by oussama m. Every woman matters reimbursement for hypertension initial screening visit.
Advances in the diagnosis and treatment of hypertension have played a major role in recent dramatic declines in coronary heart disease and stroke mortality in industrialized countries. Stage 1 hypertension is a systolic pressure ranging from to 9 mm hg or a diastolic pressure ranging from 80 to 89 mm hg. The treatment of adults with essential hypertension. Population with ckd, initial or addon therapy should include and acei or arb to improve. Diuretics as initial treatment for essential hypertension. The 2017 accaha hypertension guideline lowers the bloodpressure treatment target to less than 80 mm hg. Patients who require drug treatment for hypertension should begin with a low dose of the initial medication, and that dose should be slowly titrated upward every 1 to 2 months. Hypertension, or high blood pressure, is a very common and serious condition that can lead to or complicate many health problems. Hypertension, the elevation of systolic blood pressure, diastol ic. B c orthostatic measurement of blood pressure should be performed during initial evaluation of hypertension and periodically at followup, or when symptoms of.
309 1265 1347 1363 1466 374 536 864 734 890 628 540 514 1294 99 584 799 1380 278 1367 19 1409 525 1191 543 1208 947 835 629 1008 582 571 84 1449 1332 659 717 217 480 887 302