what is standard care for treatment of hypertension

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There are many types of complementary and alternative treatments believed to be effective for treating hypertension. Get the facts on your options. Omega-3 …

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Feb 21, 2019 · Nonpharmacological therapy is recommended for treatment of this category of blood pressure. This includes consuming a heart-healthy diet such as DASH, reducing sodium intake, increasing physical activity, limiting alcohol consumption and losing weight for those who are overweight. Reassess patients every three to six months. Stage 1 hypertension.

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Mar 01, 2022 · Lifestyle modifications are essential for managing hypertension, and optimal treatment starts with diet and activity. Dietary changes include salt reduction, moderation of alcohol consumption, and...

What is the best treatment for hypertension?

Apr 25, 2019 · Introduction. Hypertension has been identified by WHO [] as one of the most significant risk factors for morbidity and mortality worldwide and is responsible for the deaths of approximately nine million people annually [].In the UK, the National Institute for Health and Care Excellence (NICE) [] defines high blood pressure (BP), also known as hypertension, as a clinic …

What is the plan of care for hypertension?

2 rows · Mar 15, 2018 · The 2015 Canadian Hypertension Education Program recommendations for blood pressure measurement, ...

How often to see a DOC for hypertension?

Aug 02, 2021 · Another element of novelty is the focus on stress-reducing measures (such as meditation and yoga) as lifestyle modifications in reducing hypertension; these proven interventions are usually not mentioned in other guidelines due to a lack of studies using controlled experimental designs.

What are treatment options for hypertension?

What is the first line treatment for hypertension?

When should you treat hypertension?

Which are the drugs for 2nd line treatment of hypertension?

What is elevated blood pressure?

Elevated blood pressure is a systolic pressure ranging from 120 to 129 mm Hg and a diastolic pressure below (not above) 80 mm Hg. Elevated blood pressure tends to get worse over time unless steps are taken to control blood pressure. Elevated blood pressure may also be called prehypertension. Stage 1 hypertension.

What to do if you have chest pain?

If you also have chest pain, vision problems, numbness or weakness, breathing difficulty, or any other signs and symptoms of a stroke or heart attack, call 911 or your local emergency medical number. Both numbers in a blood pressure reading are important. But after age 50, the systolic reading is even more important.

How to control high blood pressure?

Try the Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes fruits, vegetables, whole grains, poultry, fish and low-fat dairy foods. Get plenty of potassium, which can help prevent and control high blood pressure. Eat less saturated fat and trans fat.

How to reduce salt in food?

While you can reduce the amount of salt you eat by putting down the saltshaker, you generally should also pay attention to the amount of salt that's in the processed foods you eat, such as canned soups or frozen dinners.

What does blood pressure measure?

A blood pressure reading, as shown in the blood pressure monitor in the image, measures the pressure in your arteries when your heart beats (systolic pressure) in the first number, and the pressure in your arteries between heartbeats (diastolic pressure) in the second number.

Why do doctors ask you to record your blood pressure?

Your doctor may ask you to record your blood pressure at home to provide additional information and confirm if you have high blood pressure.

What happens if your blood pressure is high?

If your blood pressure remains stubbornly high despite taking at least three different types of high blood pressure drugs, one of which usually should be a diuretic, you may have resistant hypertension.

What is the BP of a patient with stage 1 hypertension?

Stage 1 hypertension. Patients who have a BP reading of 130-139 mm Hg systolic and 80-89 mm Hg diastolic have stage 1 hypertension. If there is known clinical atherosclerotic cardiovascular disease, diabetes, chronic kidney disease or an estimated 10-year cardiovascular disease risk at or above 10 percent, physicians should provide nonpharmacological therapy and BP-lowering medication.

How long does it take to reassess blood pressure for stage 2 hypertension?

Stage 2 hypertension. The recommended action for a patient with stage 2 hypertension—BP readings at or above 140/90 mm Hg—is both nonpharmacological therapy and BP-lowering medication. Patients’ blood pressure should be reassessed after one month. If the blood pressure goal has been met, reassess in three to six months. However, if the BP goal was not met, physicians should assess and optimize adherence to therapy, and consider intensification of therapy.

How long does it take to reassess BP?

Reassessment should occur after one month and if the BP goal is not met, assess and optimize adherence to therapy. Physicians should also consider intensification of therapy. And if there is a less than 10 percent 10-year atherosclerotic cardiovascular disease risk, nonpharmacological therapy should be recommended with reassessment after three to six months.

What is considered elevated BP?

Elevated BP. This is defined as a BP reading of 120–129 mm Hg systolic and less than 80 mm Hg diastolic. Nonpharmacological therapy is recommended for treatment of this category of blood pressure. This includes consuming a heart-healthy diet such as DASH, reducing sodium intake, increasing physical activity, limiting alcohol consumption and losing weight for those who are overweight. Reassess patients every three to six months.

How many organizations have been recognized for blood pressure control?

In 2017, the AMA and AHA acknowledged early adopters of the recognition program by identifying over 300 organizations. And in 2018, nearly 800 organizations have been recognized for their efforts focusing on blood pressure control within the populations they serve.

What does AMA membership mean?

An AMA membership means you’re motivating millions to control hypertension. When the nation’s health is on the line, you can count on the AMA to be part of the solution. Static. Up.

What is target BP?

In addition to direct access to trained field-support specialists, a data platform and a suite of evidence-based tools and resources offered by the AMA and the AHA, Target: BP offers annual, recurring recognition for all participating sites and those that achieve hypertension control rates of 70 percent or higher among their adult patient population each year.

Why is ISH important?

Editor's Note: The ISH guidelines are important because they successfully cut the Gordian knot of conflicting diagnosis thresholds and treatment targets in hypertension. They move us away from the 2017 American College of Cardiology/American Heart Association (ACC/AHA; https://www.aafp.org/afp/2018/0315/p413.html) guidelines, which recommended a diagnosis and treatment target of 130/80 mm Hg primarily based on a few large, well-controlled trials that are difficult to replicate in practice. As Dr. Michael LeFevre noted in an AFP editorial ( https://www.aafp.org/afp/2018/0315/p372.html ), “It is an overreach to take the results of existing trial data and label everyone who has a BP above 130/80 mm Hg as having uncontrolled hypertension, particularly when that label will be applied on the basis of the most recent routine office BP measurement.” Although the ACC/AHA guidelines recommend that everyone diagnosed with hypertension be verified with home or 24-hour ambulatory monitoring, this service is not uniformly available. Similarly, the ACC/AHA guidelines did not account for the increased harms of over-treatment in older adults. For these reasons, the American Academy of Family Physicians (AAFP) declined to endorse the ACC/AHA guidelines and continues to endorse the 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults from the Eighth Joint National Committee ( https://www.aafp.org/family-physician/patient-care/clinical-recommendations/all-clinical-recommendations/highbloodpressure.html ).

What is the BP of a 24-hour ambulatory?

With 24-hour ambulatory monitoring, hypertension is diagnosed based on one of three criteria: 24-hour average BP of 130/80 mm Hg or greater, daytime average BP of 135/85 mm Hg or greater, or nighttime average BP of 120/70 mm Hg or greater.

How to reduce a swollen thigh?

Healthy drinks. Consider hibiscus tea, pomegranate juice, beetroot juice, and cocoa. Moderate consumption of coffee, and green and black tea. Physical activity. Add strength or resistance training 2 to 3 days per week.

How many drinks should I drink a day?

Limit to moderate daily consumption (i.e., 1.5 standard drinks per day for women and 2 for men)

What is the recommended blood pressure target for a 65 year old?

Recommended long-term blood pressure targets are less than 130/80 mm Hg in patients younger than 65 years and less than 140/90 mm Hg in patients 65 years or older.

How to manage hypertension?

Lifestyle modifications are essential for managing hypertension, and optimal treatment starts with diet and activity. Dietary changes include salt reduction, moderation of alcohol consumption, and a diet high in vegetables and fruit that is low in added sugars and saturated fats (e.g., DASH diet ). Activity recommendations include aerobic and resistance exercises for at least 30 minutes or more at least five days per week. Other important modifications include smoking cessation and stress reduction ( Table 2).

What are the risk factors for hypertension?

After diagnosing hypertension, further assessment is recommended to identify cardiovascular risk factors and signs of hypertension-mediated organ damage. The cardiovascular risk factors of diabetes mellitus, dyslipidemia, obesity , or nicotine use affect one-half of people with hypertension.

How many people die from hypertension annually?

Hypertension has been identified by WHO [1] as one of the most significant risk factors for morbidity and mortality worldwide and is responsible for the deaths of approximately nine million people annually [1]. In the UK, the National Institute for Health and Care Excellence (NICE) [2] defines high blood pressure (BP), also known as hypertension, as a clinic blood pressure of 140/90 mmHg or higher confirmed by a subsequent ambulatory blood pressure monitoring daytime average (or home blood pressure monitoring average) of 135/85 mmHg or higher.

How accurate is a blood pressure monitor?

Once a person has been screened and found to have high blood pressure, ambulatory blood pressure monitoring (ABPM) is regarded as the most accurate way to diagnose hypertension and is recommended by guidelines to routinely to confirm elevated blood pressure readings [2, 17, 18]. Ambulatory monitors typically involve portable, automated cuffs worn continuously that measure blood pressure every 15–30 min during the day and 15–60 min overnight [19]. Despite their utility in diagnosis, ambulatory monitors may not be available to many clinicians and patients due to cost and time limitations [19] and can be uncomfortable and disruptive to daily life and sleep [9, 20]. Advances in technology have allowed for the development of new ‘cuff-less’ BP monitoring devices however, which continuously monitor BP without disruption to daily activities. Cuff-less BP monitoring devices utilise smartphone or wearable sensor technologies that can estimate BP from ECG signals, photoplethysmogram (PPG) signals (using infrared light on the finger to estimation of skin blood flow), or a combination of both [21]. For example, one system developed consists of a wearable wrist band to collect PPG signals, a wearable heart rate belt to collect ECG signals, and a smartphone. The signals from the wearable device communicate via Bluetooth with the smartphone to synchronise their measurements and continuously stream the wearer’s blood pressure. Other devices that have been developed utilise sensors in T-shirts [22], placed behind the ear [23] and in a computer mouse [24] to calculate and record blood pressure measurements.

What is interactive digital intervention?

Interactive digital interventions now offer the ability to provide users with additional support over and above simple tele-monitoring which can also result in lower blood pressure than usual care [41]. This can include, for example, multi-media demonstrations of lifestyle advice utilising video and web links. The ‘Home BP’ trial will report later in 2019 on the effectiveness of a web-based digital intervention with a lifestyle module testing the efficacy over and above usual care [42]. Where a digital intervention utilises mobile phone technology to underpin tele-monitoring, this is increasingly termed ‘M-health’.

What is the issue with non-invasive devices?

A vital issue with both the apps and novel non-invasive devices is the lack of a universally agreed standard for the validation of this technology, and current protocols simply do not include them. There are plans to rectify this [27•] with some apps exploring clinical validation [28, 29] so the future does look brighter. At present, however, there is limited incorporation of this technology into widespread clinical practice as a result of this key issue [26].

When was the first report on paediatric hypertension published?

The first report on paediatric hypertension by the National Heart, Lung, and Blood Institute (NHLBI), published in 1977 [51] declared that “Detection and management of hypertension in children and the precursors of hypertension in adults are the next major frontier”. The report also recommended annual BP measurement in all children ≥ 3 years. Unfortunately, nearly 40 years later, the diagnosis of hypertension is missed in the majority of cases, and familiarity with paediatric hypertension among clinicians is extremely poor. This is therefore an area where the technology described above could make a real difference. However, the issues of validation of the technology are even more acute in the paediatric population because children’s vasculature and arm size are not the same as those of adults. The new universal standard provides recommendations aiming to improve this [27•].

Is hypertension a risk factor for pregnancy?

Furthermore, hypertension during pregnancy has been linked to the development of chronic hypertension and an increase in lifetime cardiovascular risk of at least double [49]. Self-monitoring of BP in pregnancy has been shown to be feasible and to have the potential to detect hypertensive disorders sooner than standard care [50]. Two large trials are currently recruiting (BUMP1 and BUMP2, https://clinicaltrials.gov/{"type":"clinical-trial","attrs":{"text":"NCT03334149","term_id":"NCT03334149"}}NCT03334149) and aim to assess whether self-monitoring improves the detection and/or control of hypertension in pregnancy. Moreover, a recent feasibility trial of self-management of BP following hypertensive pregnancy [35] demonstrated that self-management using a purpose-designed app offers great promise in optimising post-partum BP management. This app allowed women to record self-monitored BP, to receive reminders to monitor their BP, and provided real-time automated medication titration feedback based on NICE guidance at that time [49] regarding self-titration and safety. Feasibility testing suggested that this technique was acceptable, as women self-monitored daily with 85% adherence and a median accuracy of 94% and there was a significant improvement in blood pressure control. This was most marked at 6 weeks, and interestingly, the difference in diastolic readings persisted to 6 months despite all but one woman finishing therapy [35]. These findings have prompted further follow-up of the women originally in this study and a larger, pilot study on self-management in the post-partum hypertensive cohort, both commencing later in 2019.

Is hypertension a risk factor for cardiovascular disease?

Hypertension is a key risk factor for cardiovascular disease. Currently, around a third of people with hypertension are undiagnosed, and of those diagnosed, around half are not taking antihypertensive medications. The World Health Organisation (WHO) estimates that high blood pressure directly or indirectly causes deaths of at least nine million people globally every year.

What to do with uncontrolled hypertension?

Institute lifestyle measures. Use pharmacotherapy. Intensify therapy for those already on medication. Recommendations for lifestyle modification alone apply only to adults younger than 65 years who have a 10-year CVD risk of less than 10%. The guideline is, however, vague about what to do for these patients when they return for follow-up in three to six months. Intensive behavioral counseling results in an average decrease in systolic BP of about 2 mm Hg at 12 to 24 months. 9 The easy path will be to make the leap to medication, rather than leave this “disease” uncontrolled.

What is the AAFP?

The American College of Physicians and the American Academy of Family Physicians (AAFP) offer thoughtful and balanced guidance that incorporates the results of these trials for adults 60 years and older 10, 11 ( Table 2 2, 11). The AAFP has declined to endorse the ACC/AHA guideline and continues to endorse the 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults. 12, 13

What is the cutoff point for blood pressure?

Redefining a cutoff point above which the value of a physiologic measurement reflects a disease has huge implications. 1 The recently released guideline from the American College of Cardiology (ACC) and American Heart Association (AHA) on the prevention, detection, evaluation, and management of high blood pressure (BP) in adults, 2 summarized in this issue of American Family Physician, 3 lowers this cutoff from 140/90 to 130/80 mm Hg.

What is the recommended BP for a 65 year old?

Treatment is recommended for noninstitutionalized, ambulatory, community-dwelling adults 65 years and older with an average systolic BP of 130 mm Hg or above to achieve a target systolic BP of less than 130 mm Hg. (Strong recommendation based on high-quality evidence.)

What is the target BP for a 60 year old?

Initiating or intensifying pharmacologic treatment should be considered for certain adults 60 years and older with high cardiovascular risk, based on individualized assessment, to achieve a target systolic BP of less than 140 mm Hg. (Weak recommendation based on low-quality evidence.)

What is the decision regarding the intensity of pharmacologic therapy and choice of drugs?

Decisions regarding the intensity of pharmacologic therapy and choice of drugs can reasonably be made based on clinical judgment, patient preferences, and a team-based approach to assess risks and benefits for adults 65 years and older with hypertension, a high burden of comorbidities, and limited life expectancy. (Moderate recommendation based on consensus opinion.)

How long does it take to get a BP reading?

Properly obtained measurements have been the standard in clinical trials, but require about 10 minutes and are not routinely obtained in the office setting ( Table 1). Even a properly obtained office BP measurement is suboptimal for the diagnosis or management of hypertension; out-of-office readings using 12- to 24-hour ambulatory or home BP monitoring provide the best guidance. 2, 4 Enthusiasm is increasing for automated office BP meaurement, 5 which duplicates the process described in Table 1 but does so without a clinician in the examination room. BP readings obtained with this method are 5 to 10 mm Hg lower than with techniques that involve a clinician, and they more closely reflect out-of-office readings. This approach was used in the SPRINT trial (Systolic Blood Pressure Intervention Trial) 6 that was cited in the ACC/AHA guideline. Our current approach to routine office BP measurement should not be used to implement the targets recommended in this guideline.

What does BP stand for?

blood pressure (BP), the International Society of Hypertension

What is sion accompanied by?

sion are accompanied by low levels of awareness, treatment

What is the leading cause of death globally?

Raised BP remains the leading cause of death globally,

What does "sion" mean in medicine?

sion, or advising the use of single pill combination therapy.

What is the G.S.S.?

and Kapodistrian University of Athens, Greece (G.S.S.); Division of Cardiovascular Sciences, Faculty of Medicine, Biology and Health, University of

What does "dards" mean?

dards refer to minimum standards of care. To allow specifica-

Where is the George Institute for Global Health?

Faculty of Medicine, University of New South Wales, Sydney, Australia (A.E.S.); The George Institute for Global Health, Sydney, Australia (A.E.S.);

What is the blood pressure target for AHA?

A new enhancing performance measure in the AHA/ACC guideline promotes a lower blood pressure target in patients with blood pressure ≥140 mm Hg than what is recommended by other organizations. The lower blood pressure target is a systolic blood pressure (SBP) <130 mm Hg, which is suggested to further reduce the risk for cardiovascular-related complications. The Task Force also recommends bringing SBP to a level <130 mm Hg in patients with stage 1 or stage 2 high blood pressure (130-139 mm Hg and 140-159 mm Hg, respectively).

What is the AHA/ACC guideline?

A harmonizing performance measure included in the guideline is the recommendation for home blood pressure monitoring for the management of stage 2 high blood pressure. The Task Force provides details on adequate ways for patients to measure their blood pressure at home or anywhere outside the clinic.

What is the AHA/ACC?

The American Heart Association/American College of Cardiology (AHA/ACC) Task Force on Performance Measures released a guideline on clinical performance and quality measures for the care of adult patients with hypertension. The full guideline was published in the Journal of the American College of Cardiology. For this guideline, the AHA/ACC Task ...

What is the AHA/ACC Task Force?

For this guideline, the AHA/ACC Task Force reviewed evidence-based guidelines and statements on performance and quality measures of high blood pressure. Harmonizing measures aligned with recommendations from other organizations were formulated, and enhancing measures based on emerging evidence were also developed for the document. According to the Task Force, the enhancing guidelines were specifically formulated in an effort to improve the application of recommendations from the 2017 Hypertension Clinical Practice Guidelines into clinical practice.

What are structural measures?

These measures were designed to assess care at the aggregate care delivery unit level , rather than to assess care of prespecified populations with hypertension at the individual, group clinician, or health plan levels.

What is the task force on blood pressure?

The Task Force recommends using a standard protocol for uniformly measuring blood pressure in the ambulatory setting. This structural measure may assist in accurately evaluating cardiovascular disease risk and in guiding the management of hypertension.

Why is standardized decision making important?

A standardized shared-decision making process may improve treatment adherence if patients feel they are taking an active role in their care . Telehealth approaches are also recommended for some patients, based on data from meta-analyses of randomized controlled trials that indicate greater reductions in SBP and diastolic blood pressure with this method compared with usual care alone.

Diagnosis

Treatment

• Changing your lifestyle can help control and manage high blood pressure. Your doctor may recommend that you make lifestyle changes including: 1. Eating a heart-healthy diet with less salt 2. Getting regular physical activity 3. Maintaining a healthy weight or losing weight if you're overweight or obese 4. Limiting the amount of alcohol you drink Bu...

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