2023-07-04 13:52:46
The European Society for Hypertension (ESH), in collaboration with the European Renal Association (ERA) and the International Society of Hypertension (ISH), have updated guidelines on hypertension. Experts recommend starting treatment with dual therapy. Preparations are preferably taken once a day in the morning.
European and international experts have updated recommendations for the management of patients with arterial hypertension. Document published in Journal of Hypertension.
Treatment of arterial hypertension in most patients should begin with an increase in systolic pressure up to 140 mm Hg. and above, and diastolic – up to 90 mm Hg. or more. At the same time, scientists have simplified approaches to blood pressure targets: a target pressure of 120–139 mm Hg is considered normal for the vast majority of patients. However, the consensus document notes that if antihypertensive drugs are well tolerated, efforts should be made to achieve a range of 120–129/70–79 mmHg. And for elderly and debilitated patients, slightly higher targets are allowed.
Changes and additions have been made to the drug therapy strategy. For the first time, beta-blockers are included in first-choice drugs, as well as the preferred dose of drugs once a day in the morning. Experts advise starting with dual therapy for most patients. It is preferable to prescribe combined preparations, including in one tablet a renin-angiotensin blocker with a calcium blocker or with a thiazide / thiazide-like diuretic. This will reduce the number of pills taken, increase patient adherence to treatment and improve clinical outcome. If such treatment is ineffective, patients should be transferred to three-/four-component therapy.
The paper first introduced the term “true resistant hypertension”. This condition is defined as a systolic blood pressure of 140 mm Hg. and above or diastolic blood pressure from 90 mm Hg. or more under the following conditions:
ineffectiveness of triple therapy of an ACE inhibitor or angiotensin receptor blocker, a calcium receptor blocker and a thiazide / thiazide-like diuretic; insufficient control of pressure according to daily monitoring or measurements at home; with the exclusion of various causes of pseudo-resistant hypertension (especially non-adherence to treatment) and secondary hypertension.
Two treatment approaches have been proposed for this group. For the first time, renal artery denervation has been recommended for patients with an estimated glomerular filtration rate greater than 40 ml/min. And for patients with advanced kidney disease, a combined diuretic approach is proposed – chlorthalidone with a loop diuretic.
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