New hypertension guidelines released

Treatment guidelines for patients with hypertension have been updated, with a particular focus on uncomplicated hypertension.

The guideline update by clinical experts, including The George Institute's Professor Vlado Perkovic and Professor Craig Andersonwas facilitated by the National Heart Foundation of Australia and is summarised in today’s issue of the Medical Journal of Australia.

If clinic blood pressure is elevated, offering confirmation with out-of-clinic measures, such as ambulatory and home blood pressure assessment, are now recommended, as they are stronger predictors of outcome. The benefit of treatment in patients with uncomplicated mild hypertension was confirmed in a 2015 meta-analysis.

A major change from earlier guidelines is the recommendation for a lower target blood pressure (≤ 120 mmHg) in high risk patients. This change follows a trial, published in 2015, in which benefit (improved cardiovascular outcomes) was demonstrated in a selected high risk population, but with some increase in treatment-related adverse  effects.

“Selection of a blood pressure target should be based on informed, shared decision making between patients and health care providers considering the benefits and harms”, Dr Genevieve Gabb (Royal Adelaide Hospital), a clinical expert involved in the guideline update, and her co- authors wrote.

In an accompanying editorial in the MJA, Professor Garry Jennings from the Baker IDI Heart and Diabetes Institute and the National Heart Foundation of Australia commended the new guidelines, commenting that they were “adapted for Australian conditions at a time when knowledge of the field has been moving rapidly”.

Professor Jennings wrote that the new guidelines deal with the paradox that most people who have heart attacks or strokes caused by elevated blood pressure do not meet the conventional definition of hypertension.

He admitted that there were holes in the evidence base that were not helpful for clinicians needing advice for particular patients.

“In future, we need to move the emphasis from large tomes written by expert groups to providing decision support individualised to the patient,” he wrote.

Read the MJA summary of the new hypertension guidelines.