Guideline for the diagnosis and management of hypertension in adults — 2016

The National Heart Foundation of Australia has updated the Guide to management of hypertension 2008: assessing and managing raised blood pressure in adults (updated December 2010). Main recommendations • For patients at low absolute cardiovascular disease risk with persistent blood pressure (BP)≥160/100mmHg, start antihypertensive therapy. • The decision to treat at lower BP levels should consider absolute cardiovascular disease risk and/or evidence of endorgan damage, together with accurate BP assessment. • For patients at moderate absolute cardiovascular disease risk with persistent systolic BP≥140mmHg and/or diastolic BP≥90mmHg, start antihypertensive therapy. • Treat patients with uncomplicated hypertension to a target BP of <140/90mmHg or lower if tolerated. Changes in management as a result of the guideline • Ambulatory and/or home BP monitoring should be offered if clinic BP is ≥140/90mmHg, as out-of-clinic BP is a stronger predictor of outcome. • In selected high cardiovascular risk populations, aiming for a target of <120mmHg systolic can improve cardiovascular outcomes. If targeting <120mmHg, close follow-up is recommended to identify treatment-related adverse effects including hypotension, syncope, electrolyte abnormalities and acute kidney injury. Why the changes have been made • A 2015 meta-analysis of patients with uncomplicated mild hypertension (systolic BP range, 140e159 mmHg) demonstrated that BP-lowering therapy is beneficial (reduced stroke, cardiovascular death and all-cause mortality). • A 2015 trial comparing lower with higher blood pressure targets in selected high cardiovascular risk populations found improved cardiovascular outcomes and reduced mortality, with an increase in some treatment-related adverse events.