2015 Guidelines for the Management of Hypertension

2015 Guidelines for the Management of Hypertension2015 Guidelines for the Management of Hypertensio

Moderation of alcohol consumption as a recommendation in European hypertension management guidelines: a survey on awareness, screening and implementation among European physicians

Objectives: Moderation of alcohol consumption is included as a class I, level of evidence A recommendation in the current European guidelines for the management of hypertension. We investigated its awareness and self-reported implementation among European physicians across different specialties and workplaces. Design and setting: A cross-sectional survey study conducted in two annual German meetings (German Society of Cardiology and the German Society of Internal Medicine) and two annual European meetings (European Society of Hypertension and European Society Cardiology) in 2015. Participants: 1064 physicians attending the European meetings were interviewed including 52.1% cardiologists, 29.2% internists and 8.8% general practitioners. Main outcome measures: Physician screening of alcohol consumption, awareness and self-implementation of the recommendation of the current European guidelines about moderation of alcohol consumption for the management of hypertension. Results: Overall, 81.9% of physicians reported to generally quantify alcohol consumption in patients with hypertension. However, only 28.6% and 14.5% of participants reported screening alcohol consumption in their patients with newly detected or treatment-resistant hypertension. Physicians recommended a maximum alcohol intake of 13.1 +/- 11.7 g/day for women (95% CI 12.3 to 13.8) and 19.9 +/- 15.6 g/day for men (95% CI 18.8 to 20.9). In case of moderate to high alcohol consumption, 10.3% would manage only hypertension without addressing alcohol consumption, while 3.7% of the physicians would do so in case of alcohol dependence (p<0.001). Conclusions: The average amount of alcohol intake per day recommended by European physicians in this survey was in agreement with the guidelines. The low number of physicians that screen for alcohol consumption in patients with newly detected and with treatment-resistant hypertension indicates an important deficit in the management of hypertension

An Initiative to Educate and Support Young Adults Diagnosed with Hypertension

An Initiative to Educate and Support Young Adults Diagnosed with Hypertension Page Tomlinson, BS, RN, DNPc Background: Hypertension is a common diagnosis in the US with significant long-term effects. While guidelines for optimal hypertension management exist, young adults lag behind older adults in treatment and control3. The young adult is arguably more capable of lifestyle changes, primarily due to fewer physical limitations than older adults. Promotion of disease self-management is the most effective way to engage young adults in seeking control over their blood pressure1,2. Lifestyle modification as a young adult decreases costs of care and risk for cardiovascular events, while lack of guidance and support at this stage of life may increase risk for cardiac events over their lifetime. This project examined disease self-management in young adults aged 18-39 years at a local primary care office. Methods. Patients aged 18-39 years with diagnosis of hypertension were identified. A questionnaire on self-efficacy in hypertension management was sent and preference for lifestyle modification counseling (LMC) was assessed. Follow up calls placed. Semi-structured interviews conducted. Provider survey conducted. Results: Three patients discussed their experience of being diagnosed with hypertension in semi-structured interviews. Fourteen patients were not interested in participating. Provider survey (n=7) response 100%. Patient information handout created. Conclusions. While the literature demonstrates the positive effect of LMC on outcomes in hypertensive young adults, efforts to engage this population proved challenging. Young adults desire consistent guidance and support with lifestyle modification yet are unwilling to engage in lifestyle modification when they are asymptomatic and do not have rapport with the offering provider. Key Words: hypertension, young adult, support, lifestyle modification Word count [246] References: Johnson, H., Olson, A., Lamantia, J., Kind, A., Pandhi, N., Mendonça, E., Craven, M., & Smith, M. (2015). Documented lifestyle education among young adults with incident hypertension. Journal of General Internal Medicine, 30(5), 556-64. Trento, M., & Porta, M. (2012). Structured and Persistently Reinforced Patient Education Can Work. BMJ: British Medical Journal 345, e5100. Zhang, Y. E., & Moran, A. (2017). Trends in the Prevalence, Awareness, Treatment, and Control of Hypertension Among Young Adults in the United States, 1999 to 2014. Hypertension, 70(4), 736-742

2015 Guidelines for the Management of Hypertension. Part 8

Recommendations of the Polish Society of Hypertension Experts: Marcin Adamczak, Ludwina Szczepaniak-Chicheł, Marzena Chrostowska, Danuta Czarnecka, Grzegorz Dzida, Krzysztof J. Filipiak, Jerzy Gąsowski, Jerzy Głuszek, Stefan Grajek, Tomasz Grodzicki, Kalina Kawecka-Jaszcz, Beata Wożakowska-Kapłon, Beata Begier-Krasińska, Jacek Manitius, Małgorzata Myśliwiec, Anna Niemirska, Aleksander Prejbisz, Danuta Pupek-Musialik, Grażyna Brzezińska-Rajszys, Katarzyna Stolarz-Skrzypek, Agnieszka Szadkowska, Tomasz Tomasik, Krystyna Widecka, Andrzej Więcek, Adam Windak, Jacek Wolf, Tomasz Zdrojewski, Aleksandra Żurowska

Potential impact of 2018 Korean Society of Hypertension guidelines on Korean population: a population-based cohort study

Abstract Background The Korean Society of Hypertension (KSH) revised the local guidelines for hypertension in 2018. The present study sought to evaluate the potential impact of the 2018 KSH guidelines on hypertension management status among the Korean population in terms of prevalence of hypertension, antihypertensive medical treatment recommendations, and control status in Korean adults. Methods We used data from the Korea National Health and Nutrition Examination Survey to estimate the number and percentage of Korean adults who have hypertension according to blood pressure (BP) classification, are recommended to receive antihypertensive medical treatment, and are receiving medical treatment and have BP in the optimal range according to the new recommendations. Adults aged 30 years or older who participated in the survey between 2013 and 2015 were selected for this study. Results The prevalence of hypertension was 30.5% among Korean adults aged 30 years or older. The percentage of subjects who are recommended to be treated with antihypertensive medications substantially increased from 32.5 to 37.8%, which translates to 1.6 million adults. Among the hypertensive patients who were receiving medical treatment, 38.6% were shown to have adequate BP levels as recommended by the 2018 KSH guidelines compared with 51.8% according to the previous 2013 guidelines. Conclusions The present study reports the potential impact of the 2018 KSH guidelines on the prevalence of hypertension, antihypertensive medical treatment recommendations, and control status for Korean adults. The 2018 KSH guidelines recommend more intensive BP control compared with previous guidelines. This study suggests that there is large scope for improvement in hypertension management in the Korean population

Do Economic Evaluations in Primary Care Prevention and the Management of Hypertension Conform to Good Practice Guidelines? A Systematic Review

Background: Results of previous research have identified the need for further investigation into the compliance with good practice guidelines for current decision-analytic modeling (DAM). Objective: To identify the extent to which recent model-based economic evaluations of interventions focused on lowering the blood pressure (BP) of patients with hypertension conform to published guidelines for DAM in health care using a five-dimension framework developed to assess compliance to DAM guidelines. Methods: A systematic review of English language articles was undertaken to identify published model-based economic evaluations that examined interventions aimed at lowering BP. The review covered the period January 2000 to March 2015 and included the following electronic bibliographic databases: EMBASE and Medline via Ovid interface and the Centre for Reviews and Dissemination’s (CRD) NHS-EED. Data were extracted based on different components of good practice across five dimensions utilizing a framework to assess compliance to DAM guidelines. Results: Thirteen articles were included in this review. The review found limited compliance to good practice DAM guidelines, which was most frequently justified by the lack of data. Conclusions: The assessment of structural uncertainty cannot yet be considered common practice in primary prevention and management of hypertension, and researchers seem to face difficulties with identifying sources of structural uncertainty and then handling them correctly. Additional guidelines are needed to aid researchers in identifying and managing sources of potential structural uncertainty. Adherence to guidelines is not always possible and it does pose challenges, in particular when there are limitations due to data availability that restrict, for example, a validation process

Attitudes of Polish physicians towards new antihypertensive agents — a final report from the ALMONDS survey

Introduction. Arterial hypertension is the most frequent modifiable risk factor for cardiovascular disease and premature mortality globally. Availability of novel antihypertensive agents with unique pharmacological characteristics improves the efficacy and safety of antihypertensive therapy. The aim of the ALMONDS survey was to identify the attitude of Polish medical professionals towards novel pharmacological agents used in the therapy of hypertension. In particular, we sought to investigate the views regarding the “class effect” for antihypertensive agents. Material and methods. The study was conducted using a standardized survey, which was filled in by 784 specialists or trainees in cardiology, internal medicine, family medicine, and diabetology. The letter form and anonymity of the survey allowed to maximize the reliability of the collected data. Results. The majority of the study group were females 46-60 years of age. A substantial proportion of the physicians specialized in internal medicine and had more than 20 years of professional experience. The management was mostly guided by the Polish Society of Hypertension (PTNT) guidelines or the European Society of Hypertension (ESH)/European Society of Cardiology (ESC) guidelines. In patients with hypertension and coronary artery disease, the most commonly chosen drug treatment included a beta-blocker and an angiotensin-converting enzyme (ACE) inhibitor or an ACE inhibitor and a vasodilating beta-blocker. The latter combination was also selected most frequently in patients with hypertension and heart failure. In women in reproductive age, a vasodilating beta-blocker and a calcium antagonist were selected most frequently, while a combination of nebivolol and zofenopril was indicated as the best in young men with hyperkinetic circulation. In patients with resistant hypertension, the most frequently chosen regimen included furosemide, amlodipine, zofenopril, and nebivolol. Another popular combination included torasemide, lercanidipine, telmisartan, and carvedilol. Conclusions. The results of our study indicate that Polish medical professionals have clear preferences regarding specific pharmacological agents within drug classes. Vasodilating agents are preferred among beta blockers, newer agents among ACE inhibitors, dihydropyridines among calcium antagonists, and loop diuretics among diuretics. This attitude is generally consistent with the 2015 PTNT guidelines

Terapia nadciśnienia tętniczego i chorób współtowarzyszących w 2018 roku — coraz mocniejsza pozycja spironolaktonu

The PATHWAY-2 study published in 2015 has shown that spironolactone is the most effective add-on drug for the treatment of resistant hypertension. In 2016 and 2017, several studies have confirmed usefulness of spironolactone in management of hypertension and associated co-morbidities. The aim of this review is to summarize these results in context of both hypertension guidelines and clinical practice.W opublikowanym w 2015 roku badaniu PATHWAY-2 wykazano, że spironolakton jest najskuteczniejszym lekiem czwartego rzutu w terapii chorych z nadciśnieniem opornym. W latach 2016–2017 ukazały się kolejne publikacje potwierdzające przydatność spironolaktonu w leczeniu nadciśnienia tętniczego oraz chorób współistniejących. Celem niniejszego opracowania jest przybliżenie wyników tych badań w kontekście zarówno zaleceń nadciśnieniowych, jak i codziennej praktyki klinicznej

MODEL INTERVENSI HIPERTENSI DI PUSKESMAS PURWOYOSO, SEMARANG

ABSTRACT To overcome community health problems, the government has launched the Healthy Indonesia Program through Family Approach (PIS-PK) since 2015. Until early 2018 the progress of this program over regions varies. The aim of this operational research conducted in Semarang in 2018 was to provide assistance for regions in implementing PIS-PK stages based on guidelines in order to produce an intervention model that can be sustainably applied with the commitments of related sectors and community participation. The result showed that Puskesmas Purwoyoso has implemented management of health service program throughout P1, P2, and P3 stages correctly in accordance with the guidelines. Based on healthy family indicators, RW 11 Purwoyoso Village was chosen as a priority area to be intervention model of hypertension prevention. The PIS-PK indicator showed that hypertension sufferers who were regularly treated was small in number. Several models used in handling hypertension cases through community empowerment approach including picking up patients with severe hypertension; blood pressure checking activity during social group gathering, so-called ‘arisan’ (CETAR), and anti-hypertension gardens. The intervention model had been implemented and established in RW 11 of Puskesmas Purwoyoso working area, therefore, other sectors involvement and community participation in hypertension prevention were expected Keywords: Intervention model, hypertension, PIS-PK &nbsp; ABSTRAK Sejak tahun 2015 Pemerintah telah meluncurkan Program Indonesia Sehat dengan Pendekatan Keluarga (PIS PK) untuk menangani masalah kesehatan di masyarakat. Hingga awal tahun 2018, kemajuan pelaksanaan PIS PK di beberapa daerah bervariasi. Riset operasional yang dilakukan di Semarang pada tahun 2018 ini bertujuan untuk mendampingi daerah dalam melaksanakan tahapan pelaksanaan program PIS PK yang sesuai dengan pedoman, hingga menghasilkan model intervensi yang dapat diimplementasikan dengan melibatkan lintas sektor dan melibatkan peran serta masyarakat.Hasil pendampingan menunjukkan, Puskesmas Purwoyoso sudah menerapkan manajemen program pelayanan kesehatan Puskesmas melalui tahapan P1, P2, dan P3 sesuai pedoman. Berdasarkan nilai IKS dan cakupan indikator PIS PK yang belum berjalan dengan baik yaitu penderita hipertensi yang berobat teratur, maka dipilih RW 11 Kelurahan Purwoyoso sebagai wilayah prioritas untuk mendapat intervensi model penanggulangan hipertensi. Pemilihan model intervensi hipertensi melalui pendekatan pemberdayaan masyarakat adalah jemput pasien gawat hipertensi, cek tensi saat arisan (CETAR), dan taman hepi (anti hipertensi). Model intervensi telah ditetapkan dan diimplementasikan di RW 11 yang termasuk wilayah kerja Puskesmas Purwoyoso, dan diharapkan keterlibatan lintas sektor serta masyarakat untuk ikut berperan dalam penanggulangan hipertensi. Kata kunci: Model intervensi, hipertensi, PIS-P

Management of hypertension in primary care

Background: The European Society of Cardiology and the European Society of Hypertension define hypertension as systolic blood pressure ≥140 mmHg Hg, or diastolic blood pressure ≥90 mmHg Hg, or both. Hypertension is a challenging condition in view of it being asymptomatic, highly prevalent and requiring continuous follow-up by the family physician. Objective: To implement the available guidelines into clinical practice for better patient health.Method Multiple databases were used to perform the literature search including PubMed, National Institute of Clinical Excellence, Scottish Intercollegiate Guidelines Network, and the Turning Research Into Practice database. The following keywords were applied: hypertension, blood pressure, and primary care. Results: Blood pressure needs to be measured by a device which is regularly calibrated. This could be a traditional mercury sphygmomanometer, aneroid sphygmomanometer or the automated sphygmomanometer. The cuff size should be adjusted according to the patient’s arm circumference and the patient should be seated comfortably with the arm rested such that the cuff is at the same level as the heart. During the initial assessment, the blood pressure should be measured in both arms and then the arm with the highest reading is used for subsequent measurements. Ambulatory blood pressure monitoring should be offered if the blood pressure is found to be over 140/90mmHg (measured at least twice) during the initial assessment. Conclusion: Appropriate management of hypertension will contribute significantly towards an improvement in overall patient health.peer-reviewe