Guideline for the diagnosis and management of hypertension in adults — 2016. Issue 2 (18th July 2016)

• Record Type: Journal Article
• Authors: 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
• Is Part Of: Medical journal of Australia. Volume 205:Issue 2(2016)
• Page Start: 85
• Page End: 89
• Publication Date: 2016-07-18
• Subjects: Cardiovascular diseases -- General medicine -- Pharmaceutical preparations; Medicine -- Periodicals; Medicine; Médecine -- Périodiques; Medicine; Periodical; Periodicals; Electronic journals; 610
• DOI: 10.5694/mja16.00526
• Languages: English
• ISSNs: 0025-729X

Abstract

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 recommendations For 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 guideline Ambulatory 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 made A 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.