Hypertension affects 40% of adults over the age of 25 worldwide, and it represents a major risk factor for cardiovascular disease, chronic kidney disease, and death, but it often remains undiagnosed until complications arise.
Hypertension Canada releases annually-updated recommendations to guide health care providers in blood pressure management. This year they provide four new and two revised recommendations for the diagnosis, assessment, prevention and treatment of hypertension.
What are the new recommendations?
1. Automated office blood pressure (AOBP)
Automated office blood pressure is preferred for in-office measurement, as it allows the patient to be monitored alone, without any medical professional assistance. The method reduces the risk of white-coat hypertension. When using AOBP SBP > 135mmHg or DBP > 85mmHg is high.
Potassium is endorsed for blood pressure reduction. The traditional diet contains too much sodium and too little potassium. Potassium protects blood vessels from damage and keeps vessel walls from thickening. The potassium-rich diet includes white beans, spinach, baked potatoes with skin, dried apricots, yogurt.
3. Adrenal vein sampling
Adrenal vein sampling is recommended for individuals with primary hyperaldosteronism considering surgery to assess for lateralization of aldosterone (a steroid hormone) hypersecretion. Too much aldosterone can lead to lowered levels of potassium in the blood (hypokalemia) and increased hydrogen ion excretion (alkalosis). Hypertensive young people (under the age of 30), who have a strong family history of hypertension, adrenal tumors, or develop low potassium level should be screened for endocrine hypertension. Resistant hypertension can also be originated from endocrine disorders.
4. SBP <120 mmHg for aged, high-risk patients
In high-risk patients, aged over 50 years, a systolic target
What are the revised recommendations?
1. Non-fasting serum lipid profile is also accepted
There are routine laboratory tests that should be performed for the investigation of patients with hypertension. These tests include:
- blood chemistry
- fasting blood glucose and/or glycated hemoglobin
- standard 12-lead ECG
- serum lipid profile: cholesterol, lipoprotein, triglycerides
According to the revised recommendation: non-fasting serum lipid panels are also acceptable.
2. ß blocker or calcium blocker as initial therapy
According to the revised recommendation in hypertensive individuals with stable angina (without prior heart failure, myocardial infarction or coronary artery bypass surgery, a ß blocker or calcium channel blocker may be considered for initial therapy.