The AHA Guidelines and Scientific Statements Handbook

Hypertension

Clive Rosendorff

11

Introduction

Benefi ts of lowering BP

BP control rates

Blood pressure measurement in the clinic or the offi ce

Patient evaluation

Laboratory tests and other diagnostic procedures

Tr e a t m e n t

Lifestyle modifi cations

Pharmacologic treatment

Uncomplicated hypertension

Special considerations

CAD and stable angina

Unstable angina, non-ST-elevation myocardial

infarction (NSTEMI), and ST-elevation myocardial

infarction (STEMI)

Heart failure

Diabetes

Treatment

Chronic kidney disease (CKD)

Defi nition of CKD

Hypertension as a risk factor for CKD progression

Hypertension as a consequence of CKD

Lifestyle modifi cations

Pharmacologic therapy

Endocrine disease and pregnancy

African-Americans

Future directions

Acknowledgements

Introduction

This chapter on hypertension is a summary of, and

contains verbatim extracts from, the following

guideline statements: Seventh Report of the Joint

National Committee on Prevention, Detection,

Evaluation, and Treatment of High Blood Pressure

• JNC 7 (2003) [1,2]; Recommendations for Blood
  Pressure Measurement in Humans and Experimen-
  tal Animals. Part 1: Blood Pressure Measurement in
  Humans, a Statement from the Subcommittee of
  Professional and Public Education of the American
  Heart Association Council on High Blood Pressure
  Research (2005) [3]; Treatment of Hypertension in
  the Prevention and Management of Ischemic Heart
  Disease; a Scientifi c Statement from the American
  Heart Association Council for High Blood Pressure
  Research and the Councils on Clinical Cardiology
  and Epidemiology and Prevention (2007) [4];
  Dietary Approaches to Prevent and Treat Hyperten-
  sion. A Scientifi c Statement from the American
  Heart Association (2006) [5]; the American Diabe-
  tes Association Guidelines for the Treatment of
  Hypertension in Adults with Diabetes (2003) [6];
  the K/DOQI Clinical Practice Guidelines on Hyper-
  tension and Antihypertensive Agents in Chronic
  Kidney Disease (2004) [7]; and the Consensus State-
  ment of the Hypertension in African Americans
  Working Group of the International Society on
  Hypertension in Blacks on the Management of
  Hypertension in African Americans (2003) [8].
  Comparisons will also be made with the guidelines
  developed in 2007 by the European Society of
  Hypertension and the European Society of Cardiol-
  ogy [9]. The recommendations for the pharmaco-
  logic management of hypertension described in this
  chapter do not include comprehensive information
  about antihypertensive drugs; clinicians are strongly
  advised to read the FDA-approved labeling of each
  drug before prescribing. In particular each drug has
  a list of specifi c contraindications which should be
  carefully reviewed.

The AHA Guidelines and Scientific Statements Handbook
Edited by Valentin Fuster © 2009 American Heart Association
ISBN: 978-1-405-18463-2