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World Hypertension Day is celebrated every May 17 to raise awareness and promote the prevention, detection and control of hypertension. High blood pressure is the main risk factor for developing cardiovascular diseases.
More than one billion people worldwide live with high blood pressure, which is a leading cause of cardiovascular disease and premature death worldwide. The burden of hypertension is felt disproportionately in low- and middle-income countries, where two-thirds of cases are found, largely due to increased risk factors in those populations in recent decades. Additionally, about half of people living with hypertension are unaware of their condition, putting them at risk for preventable medical complications and death.
Hypertension affects more than 30% of the adult population worldwide, more than one billion people worldwide. It is the main risk factor for cardiovascular diseases, especially coronary heart disease and stroke, but also for chronic kidney disease, heart failure, arrhythmia and dementia.
The burden of hypertension is felt disproportionately in low- and middle-income countries, where two-thirds of cases are found, largely due to increased risk factors in those populations in recent decades. Additionally, about half of people living with hypertension are unaware of their condition, putting them at risk for preventable medical complications and death.
To achieve the global goal of reducing the prevalence of hypertension by 25% by 2025, WHO and the US Centers for Disease Control and Prevention launched the Global Hearts Initiative in 2016. With its five technical packages: HEARTS (control cardiovascular disease), MPOWER (control tobacco), Active (increase physical activity), SHAKE (reduce salt intake) and REPLACE (eliminate trans fats): the Initiative aims to improve heart health Worldwide. HEARTS’ own technical package provides guidance on how to more effectively detect and treat people with hypertension in primary health care. HEARTS in the Americas is currently being implemented in 22 countries in the Region, which have 1,380 health facilities participating in the initiative.
Facts about hypertension
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High blood pressure and the new ACC/AHA guidelines
The ACC/AHA hypertension guidelines cover virtually all aspects of the diagnosis, evaluation, management, secondary causes, and pharmacologic and nonpharmacologic treatment of hypertension. Substantial and appropriate emphasis has been given to the strategies necessary for accurate blood pressure measurement in any setting where valid blood pressure measurements are desired. Most "errors" made during blood pressure measurement bias readings upward, resulting in overdiagnosis of hypertension and, among those already on drug therapy, underestimation of the true magnitude of the decrease of blood pressure, resulting in overtreatment .
Hypertension is diagnosed when blood pressure is consistently ≥130 and/or ≥80 mm Hg. However, most patients with hypertension between 130 and 139/80 and 89 mm Hg (stage 1 hypertension) are not eligible for immediate drug treatment. The guide breaks new ground with some of its recommendations. Absolute cardiovascular risk is used, for the first time, to determine high-risk status when blood pressure is 130–139/80–89 mm Hg (stage 1 hypertension) and the characteristics/comorbidities of the high-risk patient are absent, even from 65 years of age. , diabetes, chronic kidney disease, known cardiovascular disease; High-risk individuals begin drug treatment when BP is ≥ 130/80 mm Hg.
The exception among high-risk individuals is for secondary stroke prevention in drug-naïve individuals, as drug therapy is initiated when blood pressure is ≥140/90 mm Hg. People who are not at high risk will start drug therapy when BP is ≥140/90 mm Hg. Regardless of the blood pressure threshold for initiation of drug therapy, the target BP is at least <130/80 mm Hg in most. However, the systolic BP target is <130 among those over 65 years of age, as the committee made no recommendation for a DBP target. Treatment should be initiated with two drugs that have complementary mechanisms of action when blood pressure is >20/10 mm Hg above target.
Blood pressure measurement Accurate measurement of blood pressure (BP) is essential for the proper diagnosis and treatment of hypertension. BP measurement is perhaps the most commonly performed procedure in clinical medicine and, although it appears simple at first glance, current suboptimal measurement leads to a negative impact on clinical management decisions in 20 to 45% of cases. Evaluating the performance of healthcare workers in measuring BP and how to improve it are key elements of a successful hypertension control program. Although office BP measurement is relatively easy, errors are common and can result in a misleading estimate of an individual’s true BP level. There are several methods to measure BP in the office. The clinical standard of auscultatory measurements calibrated on a column of mercury has given way to oscillometric devices (in part due to toxicological problems with mercury). Oscillometric devices use a sensor that detects oscillations in pulsatile blood volume during inflation and deflation of the cuff. BP is calculated indirectly from maximum amplitude algorithms involving population-based data. For this reason, only devices with a validated measurement protocol can be recommended for use . Many of the newer oscillometric devices automatically inflate multiple times (at 1 to 2 minute intervals), allowing patients to be alone and undisturbed during the measurement. Although much of the available information on BP-related risk and experience from antihypertensive treatment trials has been generated using "traditional" office BP measurement methods , there is a growing evidence base that supports the use of automated BP measurements in the office and outside the medical setting. Checklist for Accurate Blood Pressure Measurement Key steps for proper BP measurements Specific instructions Step 1 : Prepare the patient appropriately. Have the patient relax, sitting in a chair (feet on the floor, back supported) for >5 min. The patient should avoid caffeine, exercise, and smoking for at least 30 minutes before measurement. Make sure the patient has emptied his or her bladder. Neither the patient nor the observer should talk during the rest period or during the measurement. Remove all clothing covering the cuff placement site.6. Measurements taken while the patient is sitting or lying on an examination table do not meet these criteria. Step 2 : Use proper technique for BP measurements. Use a BP measurement device that has been validated and ensure that the device is calibrated periodically. Support the patient’s arm (e.g., resting on a desk). Place the center of the cuff on the patient’s upper arm at the level of the right atrium (the midpoint of the sternum). Use the correct cuff size, so that the bladder surrounds 80% of the arm, and note whether a larger or smaller cuff size than normal is used. The diaphragm or bell of the stethoscope can be used for auscultatory readings . Step 3 : Take necessary measures for the diagnosis and treatment of high blood pressure/hypertension. At the first visit, record blood pressure in both arms. Use the arm that gives the highest reading for subsequent readings. Separate repeated measurements by 1–2 min. For auscultatory determinations, use a palpated estimate of radial pulse obliteration pressure to estimate SBP. Inflate the cuff 20–30 mm Hg above this level for auscultatory determination of BP level. For auscultatory readings, deflate the cuff pressure 2 mm Hg per second and listen for Korotkoff sounds. Step 4: Properly document accurate BP readings. Record SBP and DBP. If using the auscultatory technique, record SBP and DBP as the onset of the first Korotkoff sound and the disappearance of all Korotkoff sounds, respectively, using the nearest even number. Note the time the most recent BP medication was taken before measurements. Step 5: Average the readings Use an average of ≥2 readings obtained on ≥2 occasions to estimate the individual’s BP level. Step 6: Provide BP readings to the patient both verbally and in writing. |
Lifestyle intervention
In a high percentage of adults, elevated BP is related to an unhealthy diet, lack of physical activity, and/or alcohol consumption.
Therefore, both guidelines identify lifestyle modification as the cornerstone for the prevention and treatment of hypertension (Table S3). In the ACC/AHA, a healthy diet is recommended, especially the Dietary Approaches to Stop Hypertension diet, weight loss in overweight/obese adults, reducing dietary sodium, increasing dietary potassium intake, physical activity, and moderation or abstinence from alcohol for prevention and management of hypertension. Likewise, weight loss in overweight/obese adults, reduction of sodium in the diet, physical activity and moderation in Alcohol consumption. hypertension. Both guidelines recommend smoking cessation for CVD prevention.
