Global Hypertension Practice

Patient Guideline Summary

Publication Date: June 1, 2020

Objective

Objective

This patient summary means to discuss key recommendations from the International Society of Hypertension (ISH) for global hypertension practice. It is limited to adults 18 years of age and older and should not be used as a reference for children.

Overview

Overview

  • Hypertension (high blood pressure) is a common medical condition with extensive effects throughout the body.
  • We will use the abbreviation HBP throughout this summary to refer to hypertension and BP to refer to blood pressure.
  • Most HBP has no identifiable cause, but in some cases a specific cause can be identified.
  • Some of the most common identifiable causes of HBP are substance abuse, certain kidney diseases, sleep apnea, and hormone excess.
  • Hypertension causes no symptoms.
  • This patient summary discusses the areas of concern related to HBP and the recommended management approach to deal with HBP on a global level.

Diagnosis

Diagnosis

  • Because BP varies with each heartbeat, strict rules for measuring it are necessary.
  • Multiple measurements in different environments and over time are needed.
  • Accurate instruments are required.
  • All drugs, herbs, and other exposures should be evaluated for their effect on BP and their ability to worsen the adverse effects of HBP. Some examples are:
    • Non-steroidal anti-inflammatory drugs (NSAIDs)
    • Cortisone-like drugs
    • Birth control pills
    • Drugs for depression
    • Alcohol
    • Tobacco
    • Cocaine and other stimulants
    • Herbs: Ma-huang, ginseng, liquorice, St. John’s wort, yohimbine
    • Certain cancer treatments
  • Your and your relatives’ entire medical history, a complete physical examination, and extensive laboratory testing will assure nothing important is missed.
  • If your HBP resists standard treatment, a search for an identifiable cause will be made.

Treatment

Treatment

  • Your treatment will begin with lifestyle recommendations regarding diet, exercise, stress reduction, and weight loss if you are overweight.
  • Lacking a specific cause for your HBP, a trial of medications to reduce your BP will begin.
    • There are a dozen categories of drugs to reduce BP.
    • Each drug has its own set of benefits and risks.
    • Your individual circumstances – ethnicity, age, sex, general health, other medical conditions, other drugs you are taking, previous experience with BP drugs, and more – will influence the choice of treatments.
    • Most HBP regimens include more than one drug. You will usually be started on a single drug, then followed to change or add drugs depending on your response.

Prevention

Prevention

  • The goal of treatment is to prevent diseases that HBP promotes. Your organs most likely to be affected:
    • Heart
    • Blood vessels
    • Brain
    • Kidneys
  • Maintaining ideal blood pressure by a combination of lifestyle changes and medications has a major effect on preventing these diseases and improving your quality of life.

Abbreviations

  • BP: Blood Pressure
  • HBP: High Blood Pressure
  • NSAIDs: Non-Steroidal Anti-Inflammatory Drugs

Source Citation

Unger, Thomasa; Borghi, Claudiob; Charchar, Fadic,d,e; Khan, Nadia A.f,g; Poulter, Neil R.h; Prabhakaran, Dorairaji,j,k; Ramirez, Agustinl; Schlaich, Markusm,n; Stergiou, George S.o; Tomaszewski, Maciejp,q; Wainford, Richard D.r,s,t; Williams, Bryanu; Schutte, Aletta E.v,w. 2020 International Society of Hypertension global hypertension practice guidelines. Journal of Hypertension 38(6):p 982-1004, June 2020. | DOI: 10.1097/HJH.0000000000002453 

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.