November 15th, 2013

Hypertension Treatment Algorithm Fills in for Missing Guideline

When the AHA and the ACC released four updated clinical guidelines earlier this week, a fifth document, the hypertension guideline, was conspicuous by its absence. According to the AHA and the ACC, the authors of the hypertension document have chosen to publish it independently. (No word has yet emerged about their reasons for doing so or when the document will be published.) In response, the AHA and the ACC announced that they would publish full hypertension guidelines in 2014, but in the meantime would publish a brief interim document. Now the two organizations, in conjunction with the Centers for Disease Control, have published a scientific advisory on the AHA and the ACC websites.

A treatment flowchart, Controlling Hypertension in Adults, breaks no major new ground but provides clinicians with a simple and easy hypertension algorithm. It eliminates the controversial “prehypertension” category of the previous guideline. Stage 1 hypertension is defined as an adult with a systolic blood pressure of 140-159 or a diastolic blood pressure of 90-99. Lifestyle modifications are first line therapy. Physicians may “consider adding” a thiazide diuretic. Stage 2 hypertension is anyone with a systolic blood pressure over 160 or a diastolic blood pressure over 100. In addition to lifestyle modifications, physicians should prescribe a thiazide diuretic and another drug, either an ACE inhibitor, an angiotensin-receptor blocker, or a calcium-channel blocker. An ACE inhibitor/calcium-channel blocker combination may also be considered.

The document also offers suggestions for choosing drugs in the presence of common conditions and provides a brief summary of the benefits of lifestyle modifications.

Here is the flowchart (click to enlarge):

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