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What Is New and What Is Different in Recent Guidelines on Antihypertensive Treatment? Looking Forward to Guidelines Reappraisal

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Disorders of Blood Pressure Regulation

Part of the book series: Updates in Hypertension and Cardiovascular Protection ((UHCP))

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Abstract

Some of the questions the physician is confronted with in daily practice have not received a definite answer by suitable intervention trials, and this is reflected in the vague and weak recommendations given on these questions by most guidelines. The most important of these questions concern (1) initiating drug treatment in individuals with grade 1 hypertension and low-to-moderate cardiovascular risk and (2) the systolic and diastolic blood pressure (SBP/DBP) targets to be achieved by treatment.

In the absence of specific trial evidence, meta-analyses have recently been done after stratifying available blood pressure-lowering randomized trials according to baseline (untreated) SBP/DBP or SBP/DBP achieved by treatment. Thanks to these meta-analyses, the recommendations given in 2013 by all major guidelines to initiate drug treatment in grade 1 hypertensives independent of the cardiovascular risk level can now be placed on a much firmer ground. Additionally, the statement can be made that achieving SBP values lower than 130 mmHg and DBP lower than 80 mmHg appear safe, at least in uncomplicated hypertensives, and can be associated with some further benefit provided addition of drugs or dose increase is not incrementing adverse events and, consequently, the risk of permanent treatment discontinuations.

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Authors and Affiliations

  1. University of Milan, Milano, Italy

    Alberto Zanchetti (Emeritus Professor, Scientific Director)

  2. Istituto Auxologico Italiano IRCCS, Milano, Italy

    Alberto Zanchetti (Emeritus Professor, Scientific Director)

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  1. Alberto Zanchetti
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Correspondence to Alberto Zanchetti .

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Editors and Affiliations

  1. Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon

    Adel E. Berbari

  2. Emeritus Professor of Medicine, University of Milano-Bicocca, Monza, Italy

    Giuseppe Mancia

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Zanchetti, A. (2018). What Is New and What Is Different in Recent Guidelines on Antihypertensive Treatment? Looking Forward to Guidelines Reappraisal. In: Berbari, A., Mancia, G. (eds) Disorders of Blood Pressure Regulation. Updates in Hypertension and Cardiovascular Protection. Springer, Cham. https://doi.org/10.1007/978-3-319-59918-2_47

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  • DOI: https://doi.org/10.1007/978-3-319-59918-2_47

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-59917-5

  • Online ISBN: 978-3-319-59918-2

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