This section of the site on hypertension guidelines even though relevant and worth reading to ordinary readers including hypertension patients, it is also targeted at medical practitioners who deal with hypertension management on a daily basis.
Hypertension guidelines are designed for the more effective management of hypertension in clinical practice. They are refereed to by doctors and practitioners time and again in treating and dealing with with specific types of hypertension such as malignant hypertension and pulmonary hypertension symptoms.
7.1 million people die from high blood pressure on an annual basis worldwide. The causes of hypertension are not fully known. Added to that hypertension symptoms are not always present and often surface when its getting very late. Management of hypertension is therefore a worldwide issue with most of diagonised hypertensives inadequately controlled. This is critical for the purposes of hypertension treatment.
Hypertension guidelines are updated on a regular basis and it follows that the leading institution to issue guidelines is the UN's World Health Organization (WHO). The American Heart Association also publishes guidelines on hypertension as well as some institutions in the UK such as the National Institute for Health and Clinical Excellence a part of the NHS. Other many health and medical institutions at a national level in different countries may also release own guidelines.
Guidelines for hypertension amongst other specific things are designed and meant to;
At the WHO level in 1999 there were some guidelines in use which were eventually updated in 2003 after some key weaknesses were pointed within the medical community;
The said update of the guidelines that followed in 2003 emphasized an evidence based process for recommendations. The group of experts involved this time represented key constituencies namely general practitioners, doctors, nurse practitioners and specialists. Potential conflict of interest was also fully disclosed and would be fully disclosed going forward. All expenses for the 2003 hypertension guidelines update were paid for by the WHO itself.
Evidence that is showing up supporting the various hypertension guidelines on hypertension management indicate that of all disease burden facing the globe today; hypertension holds a 4.5% stake and is present in both developed and developing societies. The current prevalence of hypertension in developing country's urban societies is as high as those recorded in developed countries.
The WHO 2003 update on guidelines for hypertension further argues that it is increasingly evident that risks of stroke, ischemic heart disease and renal failure are not confined to a subset of the population with particularly high levels of blood pressure. The risks rather occur in a continuum, affecting even those below average levels of BP.
The World Health Organisation in its hypertension guidelines notes that when deciding on hypertensive management in patients; more than blood pressure numbers should be taken into account but also the presence of other cardiovascular risk factors, target organ damage and associated clinical conditions.
The UN notes that there is obviously a strong link between high blood pressure and cardiovascular disease as blood pressure induced cardiovascular risk rises continuously across the whole blood pressure range.
The following are some guidelines issued in 2006 (but still valid in early 2010) by the British NHS. Please note that hypertension guidelines are constantly updated based on new findings and development of new drugs for treatment amongst other things and should constantly be checked for relevancy;
In April 2008 for the first time ever the American Heart Association issued specific hypertension guidelines to assist patients and health care providers to deal with resistant hypertension that seems to stubbornly defy treatment.
According to the American Heart Association high blood pressure is said to be defiant if it remains above goal despite the taking of three medications to lower it. Hypertension that is under control but requires more medication i.e four or more drugs to treat is also called resistant to treatment. It is estimated that up to 30% of people with high blood pressure may actually be suffering from resistant hypertension.
The hypertension guidelines offer specific recommendations if resistant high blood pressure is to be treated;
Weight - weigh loss has tremendous benefits to patients including use of less drugs. Obesity is associated with more severe hypertension. There is also relationship between caffeine and blood pressure which might result in spikes in blood pressure especially in hypertension-prone individuals like those who are obese
Sodium - Reducing salt intake to 2300mg per day or even 1500mg per day is immensely beneficial even in salt-sensitive patients. Links have been established between high dietary salt intake and hypertension. the association between salt and high blood pressure is well researched.
Alcohol - Heavy alcohol consumption should be strongly discouraged as it is associated with resistant high blood pressure. The association between alcohol and high blood pressure is well known to be harmful.
Withdraw interfering drugs - There are specific drugs that increase blood pressure such as aspirin that should be removed or withdrawn. A more effective regimen of drugs to reduce hypertension must be used.
Diuretics - have to used used effectively and in correct amounts. Hypertension clinics report treatment resistance associated with lack of or under use of diuretics for high blood pressure
Dose timing - patients taking any of their hypertensive drugs at bedtime have shown great benefit particularly lower nighttime blood pressure.
Adherence - some patients have a tendency to drop things and skip normal prescribed dosage and treatment regimes. Whilst it may prove expensive to implement case specific attention and management this may produce better results in dealing with hypertension treatment resistance in patients.
Multi-drug regimens - drug combination must be tailored to individual needs taking into account previous benefit, history of adverse effects, and other medical conditions that would include kidney disease, diabetes and others as well as patient financial limitations which might also play into adherence above.
Mineralocorticoid receptor antagonist - may provide considerable hypertensive benefit when added to existing multi-drug regimens.
As demonstrated above, hypertension guidelines are indispensable. They are essential for practitioners as well as for researching patients to know what affects their health and quest to control, reduce or eliminate high blood pressure.
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