File Name: hypertension clinical care and level blood pressure control .zip
- Everything you need to know about hypertension
- Hypertension clinical information and guidelines
- 2018 ESC/ESH Clinical Practice Guidelines for the Management of Arterial Hypertension
To measure your blood pressure, a specialist places an inflatable cuff around your arm and measures your blood pressure using a pressure-measuring gauge. 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. Your doctor will ask questions about your medical history and do a physical examination.
We include products we think are useful for our readers. If you buy through links on this page, we may earn a small commission. Hypertension is another name for high blood pressure.
Everything you need to know about hypertension
Elevated blood pressure BP is the leading cause of mortality and disease burden 1 , 2. Elevated systolic BP was responsible for Elevated BP has been shown to account for The impact of the new guideline is expected to be immense.
Muntner et al. The radical changes in the recommendations have sparked fierce debates among researchers and practitioners 12 , 13 , In this study, we sought to estimate the potential impact of the new hypertension guideline on clinical practice in Korea. We specifically attempted to determine the following: how many people would be classified as having hypertension, how many among them would be recommended pharmacologic treatment, and whether more aggressive BP goals would lead to better cardiovascular outcomes.
Detailed information on socioeconomic status, health and dietary behaviors, quality of life, healthcare utilization, anthropometric measures, and biochemical profiles are included in the database.
Subjects representative of the Korean population were chosen for this study using a complex, stratified, multistage, cluster sampling method. We calculated the final BP value from the average of the second and third measurements The sample weights were constructed by accounting for the complex survey design, survey non-response, and post-stratification. Among a total of 22, subjects who participated in the KNHANES VI between and 8, in , 7, in , and 7, in , 15, adults aged 30 years or older were analyzed in this study.
The National Health Insurance Service is the single insurance provider in Korea covering all citizens. Enrollees in the insurance system are entitled to standardized medical examinations biennially, including standardized self-reporting questionnaires on lifestyle, medical history, height, weight, blood pressure measurements, and laboratory tests. The Seoul National University Hospital Institutional Review Board approved this study I and waived the mandate for obtaining informed consents.
This study was conducted according to the relevant guidelines and national regulations. The subjects who were already taking antihypertensive medications were also regarded as having hypertension and meeting both criteria for medical treatment.
Any subjects who had experienced myocardial infarction MI , heart failure HF , or stroke before the diagnosis of hypertension were excluded from this analysis. Study subjects were followed up until the occurrence of the primary endpoint, until death, or until the end of the cohort December 31, Vital status was confirmed using the national administrative death records.
The primary endpoint was major cardiovascular events, comprising a composite of cardiovascular death, MI, HF, and stroke. The secondary endpoints included all cause death and each separate component of the primary endpoint. The variables representing strata, cluster, and weight were included in the raw data. Cox proportional hazard models were used to evaluate the associations between levels of BP control and the occurrence of major cardiovascular events.
We performed multivariable regression analyses with adjustments for age, sex, baseline systolic BP, baseline diastolic BP, body mass index, diabetes, dyslipidemia, malignancy, renal disease, liver disease, chronic pulmonary disease, rheumatic disease, and smoking status. Propensity score matching was performed using the aforementioned variables. The prevalence of hypertension was estimated to be A total of 5. The risk profiles of the 5. The estimated year atherosclerotic cardiovascular disease risk was 8.
BP-lowering medications are recommended in This is in contrast with the JNC8 guideline which showed a small difference between the prevalence of hypertension A total of 1. Among various indications, the presence of cardiovascular disease and high risk of atherosclerotic cardiovascular disease were the predominant indications see Supplementary Fig.
The hypertension control rate used to be This was due to both an increase in the number of hypertensive subjects and the more stringent target BP goal. We extracted follow-up data spanning a median of The data were obtained from a total of , hypertensive individuals with no previous history of major cardiovascular events. The overall annualized year cardiovascular event rate was 7.
Restricted cubic spline curve of achieved blood pressure and adjusted risk of cardiovascular events: left systolic blood pressure, and right diastolic blood pressure. The distributions of achieved systolic and diastolic blood pressure are also shown bars.
Whereas age did not differ significantly between the groups, there was a trend toward a higher prevalence in men and higher risk profiles among the less stringently defined groups. Survival free from the primary endpoint, a composite cardiovascular death, MI, HF, and stroke, is depicted in Fig.
The year annualized rates of the primary endpoint were 5. This finding was consistent across each component of the primary endpoint, but was greater for stroke. Models adjusted for multivariable and matched with propensity score see Supplementary Fig. S3 also confirmed these observations. A subgroup analysis revealed that the benefits of stricter BP control were consistent regardless of the presence of diabetes or chronic kidney disease see Supplementary Fig.
Kaplan-Meier survival curve free from major cardiovascular events among hypertensive subjects according to their achieved blood pressure. A sensitivity analysis was done for , hypertensive patients who were taking BP-lowering medicines. Survival analyses corroborated the study findings see Supplementary Fig.
This study showed a substantial increase in the prevalence of hypertension from However, the number of adults for whom BP-lowering medical treatment was recommended was modestly increased from This study showed that nearly a half of Korean adults would be diagnosed with hypertension based on the new guideline.
A substantial proportion of them would be recommended for non-pharmacologic treatments initially. Numerically speaking, among the 5. Strong evidence exists supporting the efficacy and safety of non-pharmacological interventions such as weight reduction, healthy diet, sodium restriction, physical activity, and moderation in alcohol consumption 23 , 24 , It has long been debated whether tighter BP control results in better clinical outcomes.
The trial enrolled high-risk patients mean Framingham yr cardiovascular disease risk: For example, the Heart Outcomes Prevention Evaluation HOPE -3, which enrolled intermediate-risk hypertensive patients without previous cardiovascular disease, failed to demonstrate a significant risk reduction with intensive antihypertensive therapy The findings of our study correspond to the current evidence supporting intensive BP control in the general population.
The study subjects exhibited a low-risk profile with no previous history of major cardiovascular events, and the actual year event rate was as low as 7. The achieved BP in this study In addition, we found no significant interactions according to the presence of diabetes or chronic renal disease. Previous studies have consistently shown poor status of hypertension control in the real world. The control rate among all hypertensive patients in Korea is no higher than This study also expected that tighter BP control would be required for more than 5 out of 6 Korean hypertensive patients if the new treatment targets are endorsed.
Recently, the new European Guidelines for the treatment of high BP was presented at the European Society of Hypertension meeting The full text will be published during the upcoming European Society of Cardiology congress The Korean Society of Hypertension also released its preliminary guideline in written in Korean language However, the new guidelines commonly recommend stricter BP control than recommended in their previous versions 28 , This study has several limitations.
Repeated visits or ambulatory measurements have been shown to minimize the chance of misclassifications Third, achieved BPs were defined by the mean of randomly collected BP measurements rather than repeated measurements with predefined protocols. Fourth, lifestyle intervention was not considered in this study. Lifestyle changes such as a healthy diet, sodium restriction, potassium supplementation, increased physical activity, and a reduction in alcohol consumption have been shown to be effective in lowering BP.
They have also been shown to have additional health benefits beside the BP-lowering effects. Finally, there may be other confounders that were not adjust for in this study such as initiation of antihypertensive medication and statin use. A substantial number of adults who had not been considered hypertensive were classified as having hypertension. Approximately one third of them met the indication for pharmacologic antihypertensive treatment. World Health Organization. Global status report on noncommunicable diseases Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, — a systematic analysis for the Global Burden of Disease Study Lancet , — A global brief on Hypertension.
Forouzanfar, M. JAMA , — Lewington, S. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Chobanian, A. Hypertension 42 , — J Hypertens 31 , —
Hypertension clinical information and guidelines
Blood pressure control in hypertensive patients within Family Health Program versus at Primary Healthcare Units: analytical cross-sectional study. I MSc. Address for correspondence. Efforts are being made within primary care to achieve adequate hypertension control. The Family Health Program FHP has the aims of promoting quality of life and intervening in factors that put this at risk. The objective of this study was to evaluate the rate of blood pressure control among patients followed up at FHP units compared with those at primary healthcare units PHUs. The diagnosis of hypertension was based on the Fourth Brazilian Hypertension Consensus, and the patients needed to have been under follow-up at the units for at least 12 months.
Blood pressure relationship with risk of cardiovascular and renal events. Importance of hypertension-mediated organ damage in refining cardiovascular risk assessment in hypertensive patients. Advantages and disadvantages of ambulatory blood pressure monitoring and home blood pressure monitoring. Clinical indications for out-of-office blood pressure measurements. Using hypertension-mediated organ damage to help stratify risk in hypertensive patients. Hypertension-mediated organ damage regression and cardiovascular risk reduction with antihypertensive treatment.
This in- cludes expanding patient and healthcare provider awareness, appropriate lifestyle modifications, access to care, evidence- based treatment, a high level.
2018 ESC/ESH Clinical Practice Guidelines for the Management of Arterial Hypertension
Distribution of blood pressure BP control based on 4 methods of assessment and 3 criteria for control. Arch Intern Med. Our findings indicate that evaluation of BP control in a large health maintenance organization will find substantial room for improvement, and clinicians should be encouraged to be more aggressive in their management of hypertension, especially with regard to the systolic BP, which until recent years has been underemphasized. Hypertension is an important health problem for more than 50 million Americans.
Clinical information for diagnosis and management of atrial fibrillation Clinical resources for health care professionals to improve the management of patients with heart failure. Heart Health Checks have been supported by Medicare since April Should population-based CVD risk assessment models make way for individualised risk prediction techniques? Discover a range of heart failure tools derived from the guidelines for the Prevention, Detection, and Management of Heart Failure in Australia
Blood pressure is the force of your blood pushing against the walls of your arteries. Each time your heart beats, it pumps blood into the arteries.
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На черном поле светилось небольшое желтое окно, на котором виднелись две строчки: ВРЕМЯ ПОИСКА: 15:09:33 ИСКОМЫЙ ШИФР: Сьюзан недоуменно смотрела на экран. Получалось, что ТРАНСТЕКСТ трудится над шифром больше пятнадцати часов. Она хорошо знала, что процессор перебирает тридцать миллионов паролей в секунду - сто миллиардов в час.
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