Asx HTN <220/120 without complaints.
HTN urgency >220/120 w/o end organ damage.
HTN emergency >220/120 + end organ damage.
When to treat asx HTN?
If BP >165/105 + Cr >2, start two agents.
or >220/>120 without any dysfunction, two agents.
If 140-165: Controversial, but at the very least, tell the pt and Fast-track them.
It is safe to continue taking your blood-pressure medications, researchers said.
Managing hypertension matters in the fight against COVID-19 too. What’s known about COVID-19 so far suggests that people with pre-existing conditions such as hypertension, diabetes and heart disease can experience severe complications when infected with SARS-CoV-2, the virus that causes COVID-19.
#1 most common mistake = overdiagnosis of hypertensive emergency among patients with scary high Bp but no target organ damage. This isn't a hypertensive emergency...
Mean Arterial Pressure = 1/3(SBP) + 2/3(DBP). MAP = [2(diastolic Bp) + Systolic Bp]/3 - A MAP ≥ 60 mmHg is believed to be needed to maintain adequate tissue perfusion.
A MAP ≥ 65 mmHg is recommended in patients with severe sepsis and septic shock by the Surviving Sepsis Campaign Guidelines Committee.
Acute blood pressure management in the emergency department is in my mind one of the most confusing and controversial topics in emergency medicine. Different blood pressure targets have been proposed for a variety of emergency medical and traumatic conditions. Guidelines are made to benefit the majority of patients with each condition but it is always necessary to consider individual factors such as age, preexisting uncontrolled hypertension and other comorbidities.
The new hypertension recommendations say doctors should consider prescribing blood-pressure drugs to patients age 60 and over whose levels are 150/90 or higher. The previous threshold was 140/90.
The prevalence of arterial hypertension, particularly systolic hypertension, is constantly rising worldwide. This is mainly the clinical expression of arterial stiffening as a result of the population’s aging. Chronic elevation in blood pressure represents a major risk factor not only for cardiovascular morbidity and mortality but also for cognitive decline and loss of autonomy later in life.
A suggested treatment protocol for moderate hypertension of >20 mm Hg above goal is: An ACE inhibitor or an ARB with a diuretic or a dihydropyridine (DHP) calcium channel blocker (such as amlodipine, felodipine, or nifedipine) combination. Start with a low dose and titrate upward.
High blood pressure, previously defined as 140/90 mm Hg or higher, is now defined as 130/80 mm Hg or higher. This change reflects the latest research that shows health problems can occur at those lower levels.
The 2017 guideline is an update of the “Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure” (JNC 7), published in 2003. The 2017 guideline is a comprehensive guideline incorporating new information from studies regarding blood pressure (BP)-related risk of cardiovascular disease (CVD), ambulatory BP monitoring (ABPM), home BP monitoring (HBPM), BP thresholds to initiate antihypertensive drug treatment, BP goals of treatment, strategies to improve hypertension treatment and control, and various other important issues.
Many natural compounds in food, as well as certain nutraceutical supplements, vitamins, antioxidants, or minerals, can mimic drugs, functioning in a similar fashion to a specific class of antihypertensive medications. However, they may be less potent and take longer to work than the antihypertensive drug. When used in combination with other nutrients and nutraceutical supplements, though, the antihypertensive effect can be magnified.
Similar reductions in blood pressure were found to be associated with new use of CCB as with new use of ACEI/ARB in non-black people who did not have diabetes, both in those who were aged younger than 55 and those aged 55 and older.
To align with its mission to reduce the global burden of raised blood pressure (BP), the International Society of Hypertension (ISH) has developed worldwide practice guidelines for the management of hypertension in adults, aged 18 years and older.
Angiotensin receptor blockers (ARBs) were found to be equally effective to angiotensin-converting enzyme (ACE) inhibitors for first-line treatment of hypertension; however ARBS may be less likely to cause adverse effects, according to the findings of a multinational cohort study recently published in Hypertension.
The American Heart Association and the European Society of Hypertension/European Society of Cardiology (ESH/ESC), as well as various meta-analyses, all concluded that the amount of blood pressure reduction is the major determinant of reduction in cardiovascular risk in both younger and older patients with hypertension, not the choice of antihypertensive drug.
Thiazides best first choice for hypertension... The treatment effect for first‐line ACE inhibitors was similar to low‐dose thiazides but less robust, and ACE inhibitors are more expensive than thiazides. First‐line low‐dose thiazides reduced all morbidity and mortality outcomes in adult patients with moderate to severe primary hypertension. First‐line ACE inhibitors and calcium channel blockers may be similarly effective, but the evidence was of lower quality. First‐line high‐dose thiazides and first‐line beta‐blockers were inferior to first‐line low‐dose thiazides.
Taking blood pressure medication at bedtime rather than on waking halves the risk of events such as heart attack and stroke, a major study has revealed.
Experts say the findings could potentially transform the way such medications are prescribed, but questions remain, not least why taking the medication at night has such a profound effect.
Hypertension is one of the most common conditions seen in primary care clinics and emergency departments (EDs). Frequently, patients are found to have asymptomatic hypertension and referred to EDs for management, despite the fact that rapidly lowering blood pressure is not necessary and may be harmful. Yet many clinics still refer these patients for emergent management.
This article will elaborate the pros and cons of a two-drug regime at the start of treatment in newly diagnosed hypertensive patients, and whether the benefits outweigh the potential risks.
A rapid, marked and persistent rise in blood pressure (BP) levels above 180/120 mmHg is a clinical condition currently defined as hypertensive emergency or urgency in the presence or absence of acute signs of hypertension-mediated organ damage, respectively.
Once a physician decides to prescribe medication to control a patient’s high blood pressure, the next decision — which one to choose — is complicated.
People who are just beginning treatment for high blood pressure can benefit equally from two different classes of medicine – angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) – yet ARBs may be less likely to cause medication side effects, according to an analysis of real-world data published on July 26, 2021, in Hypertension, an American Heart Association journal.
Modern hypertension guidelines are evidence-based in that they recommend medical treatments that have been proven effective in lowering blood pressure and preventing cardiovascular disease outcomes and death in randomised controlled clinical trials and/or in well-designed observational studies with large patient populations.
The potential upside from this change is that because of “awareness,” more people might make lifestyle changes that lead to lower cardiovascular risk in the future. The potential downside is that more people may receive a diagnosis of high blood pressure, be overtreated with medication, and endure side effects or adverse outcomes. It’s not irrational to fear that these new guidelines might lead to more of the latter than the former.
“Finding the right combination of medications for uncontrolled hypertension may require some trial and error,” says hypertension specialist George Thomas, MD. In his work with patients, Dr. Thomas investigates possible explanations for difficulty in controlling blood pressures. These can include...
Target: BP™ is a national initiative formed by the American Heart Association (AHA) and the American Medical Association (AMA) in response to the high prevalence of uncontrolled blood pressure (BP). Target: BP helps health care organizations and care teams, at no cost, improve BP control rates through an evidence-based quality improvement program and recognizes organizations committed to improving BP control.
It is important to take your blood pressure medicine exactly as your doctor tells you to. Do not stop taking your current medicine without talking to your doctor or pharmacist first. Stopping your blood pressure medicine without first talking to your health care team could lead to serious health consequences.