Hypertension Canada's 2017 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults.

Hypertension Canada provides annually updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension. This year, we introduce 10 new guidelines. Three previous guidelines have been revised and 5 have been removed. Previous age and frailty distinctions have been removed as considerations for when to initiate antihypertensive therapy. In the presence of macrovascular target organ damage, or in those with independent cardiovascular risk factors, antihypertensive therapy should be considered for all individuals with elevated average systolic nonautomated office blood pressure (non-AOBP) readings ≥ 140 mm Hg. For individuals with diastolic hypertension (with or without systolic hypertension), fixed-dose single-pill combinations are now recommended as an initial treatment option. Preference is given to pills containing an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in combination with either a calcium channel blocker or diuretic. Whenever a diuretic is selected as monotherapy, longer-acting agents are preferred. In patients with established ischemic heart disease, caution should be exercised in lowering diastolic non-AOBP to ≤ 60 mm Hg, especially in the presence of left ventricular hypertrophy. After a hemorrhagic stroke, in the first 24 hours, systolic non-AOBP lowering to < 140 mm Hg is not recommended. Finally, guidance is now provided for screening, initial diagnosis, assessment, and treatment of renovascular hypertension arising from fibromuscular dysplasia. The specific evidence and rationale underlying each of these guidelines are discussed.

[Sex-specific antihypertensive drug therapy]. / Geschlechtsspezifische medikamentöse Therapie der Hypertonie.

BACKGROUND: Hypertension is a leading cause of cardiovascular diseases. To evaluate sex-specific differences in the prescription pattern of antihypertensive therapy, registry data from the regional health insurance fund "Burgenländische Gebietskrankenkasse" (BGKK) were analyzed. MATERIAL AND METHODS: In a retrospective cross sectional cohort study data from 41499 individuals covered by the BGKK in 2003, and who had been treated with cardiovascular drugs were analyzed. Data were evaluated according to drug classifications. RESULTS: Among subjects treated with cardiovascular medication 38.3 % were males and 61.7 % females. The drug classes acting on the renin-angiotensin-system were prescribed more frequently than beta-blockers, calcium channel blockers, diuretics and antihypertensives. Women were treated more often with diuretics and beta-blockers, whereas men received more antihypertensives and drugs acting on the renin angiotensin system (p < 0.01 between groups of sexes). CONCLUSION: Sex-specific differences exist regarding the prevalence of antihypertensive drug prescriptions between men and women. Further, the prescription pattern of equivalently effective medications differs between sexes.

Diuréticos em hipertensäo arterial: por que, como e quando? / Diuretics in arterial hypertension: why, how and when?

Os objetivos terapêuticos em hipertensão não se limitam somente à redução dos níveis de pressão arterial, mas abrangem outros compromissos, como a maximização dos efeito benéficos na morbidade e na mortalidade cardiovasculares, e no controle ou na redução dos fatores de risco, entre outros, sem inconvenientes aos pacientes. Sem comprometer esses objetivos, diuréticos em biaxas doses devem ser opções preferenciais em monoterapia, junto com betabloqueadores, desde que seu uso não seja contra-indicado, ou que haja indicação específica para outra classe de drogas. Permanece, todavia, um desafio a ser enfrentado no sentido de demonstrar que ganhos adicionais na redução de morbidade e de mortalidade possam ser obtidos com outras drogas. Todavia, mais do que exercerem seu papel de terapeutas, têm os profissionais de saúde, particularmente os médicos, o compromisso de ulutrapassar sua deficiência no papel de educadores, para que maiores ganhos sejam conquistados na detecção, no tratamento e no controle da hipertensão.