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Hypertension; Grey Zones, Future Perspectives

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Hypertension and Cardiovascular Disease

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Abstract

Hypertension is a growing threat and a major risk factor for cardiovascular disease worldwide. It is therefore crucial that physicians properly identify hypertensive patients and treat them accordingly in order to prevent the devastating complications of this condition. However, the guidelines for hypertension management proposed by international societies do not all concur, thereby creating grey zones or even confusion for doctors when called upon to make a therapeutic decision. Specifically, according to the American guidelines (JNC8, ASH/ISH and ACC/AHA/CDS) subjects with office BP levels ≥140/90 mmHg, confirmed by repeated measurements are characterized as hypertensives. Besides, the European guidelines (2013 ESH/ESC and the UK guidelines) suggest ambulatory or home monitoring to confirm HTN.

Such disagreements between guidelines have highlighted the need for new, large randomized controlled trials and meta-analyses to allow for a more rational decision to be made regarding when to treat, whom to treat, and how to treat. In this chapter, we discuss and underline the differences between current hypertension guidelines and specify the importance of making an accurate diagnosis of hypertension based on the use of appropriate blood pressure measurement devices and techniques. Moreover, the optimal blood pressure target has recently become the topic of considerable debate. Whether lower systolic blood pressure cut-off points are needed to be reached in order to reduce global cardiovascular risk, and whether such instructions will be incorporated in new clinical guidelines remains to be seen in the years to come.

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Abbreviations

ABP:

Ambulatory Blood Pressure

ACC:

American College of Cardiology

ACCORD BP:

Action to Control Cardiovascular Risk in Diabetes Blood Pressure

ACEI:

Angiotensin Converting Enzyme Inhibitor

AF:

Atrial Fibrillation

AHA:

American Heart Association

AOBP:

Automated Office Blood Pressure

ARB:

Angiotensin Receptor Blocker

ASH:

American Society of Hypertension

BB:

B-blocking agent

BHS:

British Hypertension Society

BP:

Blood pressure

CAD:

Coronary Artery Disease

CBP:

Central Blood Pressure

CCB:

Calcium Channel Blocker

CDC:

Centers for Disease Control

CHD:

Coronary Heart Disease

CHEP:

Canadian Hypertension Education Program

CKD:

Chronic Kidney Disease

CVD:

Cardiovascular Disease

DBP:

Diastolic Blood Pressure

DM:

Diabetes Mellitus

ESH:

European Society of Hypertension

GFR:

Glomerular Filtration Rate

HBP:

Home Blood Pressure

HTN:

Hypertension

INVEST:

International Verapamil-Trandolapril Study

ISH:

International Society of Hypertension

JAMA:

Journal of the American Medical Association

JNC 7:

Seventh Joint National Committee

JNC 8:

Eighth Joint National Committee

JSH:

Japanese Society of Hypertension

LVMI:

Left Ventricular Mass Index

MH:

Masked Hypertension

NEJM:

New England Journal of Medicine

NH:

Nocturnal Hypertension

NHANES:

National Health and Nutrition Examination Survey

NICE:

National Institute of Health and Care Excellence

NIH:

National Institute of Health

OBP:

Office Blood Pressure

PCNA:

Preventive Cardiovascular Nurses Association

SBP:

Systolic Blood Pressure

SPRINT:

Systolic Blood Pressure Intervention Trial

TIA:

Transient Ischemic Attack

TOD:

Target Organ Damage

VALUE:

Valsartan Antihypertensive Long-term Use Evaluation Study

WCE:

White Coat Effect

WCH:

White Coat Hypertension

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Authors and Affiliations

  1. 4th Department of Internal Medicine, “Evangelismos” State General Hospital, AHEPA Building, Room 528, Ipsilantou 45-47, Athens, ATT, 13122, Greece

    Emmanuel A. Andreadis M.D., Ph.D.

  2. Hypertension and Cardiovascular Disease Prevention Outpatient Clinic, “Evangelismos” State General Hospital, Athens, Greece

    Emmanuel A. Andreadis M.D., Ph.D.

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Correspondence to Emmanuel A. Andreadis M.D., Ph.D. .

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  1. Fourth Internal Medicine Department, Evangelismos State General Hospital, Athens, Greece

    Emmanuel A. Andreadis

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Andreadis, E.A. (2016). Hypertension; Grey Zones, Future Perspectives. In: Andreadis, E. (eds) Hypertension and Cardiovascular Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-39599-9_22

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