ABSTRACT
Hypertension is the most important risk factor for global disease burden. Detection and management of hypertension are considered as key issues for individual and public health, as adequate control of blood pressure levels markedly reduces morbidity and mortality associated with hypertension. Aims of these practice guidelines for the management of arterial hypertension of the Spanish Society of Hypertension include offering simplified schemes for diagnosis and treatment for daily practice, and strategies for public health promotion. The Spanish Society of Hypertension assumes the 2018 European guidelines for management of arterial hypertension developed by the European Society of Cardiology and the European Society of Hypertension, although relevant aspects of the 2017 American College of Cardiology/American Heart Association guidelines and the 2020 International Society of Hypertension guidelines are also commented. Hypertension is defined as a persistent elevation in office systolic blood pressure ≥ 140 and/or diastolic blood pressure ≥ 90 mmHg, and assessment of out-of-office blood pressure and global cardiovascular risk are considered of key importance for evaluation and management of hypertensive patients. The target for treated blood pressure should be < 130/80 for most patients. The treatment of hypertension involves lifestyle interventions and drug therapy. Most people with hypertension need more than one antihypertensive drug for adequate control, so initial therapy with two drugs, and single pill combinations are recommended for a wide majority of hypertensive patients.
Subject(s)
Antihypertensive Agents , Hypertension , Humans , Antihypertensive Agents/therapeutic use , Hypertension/diagnosis , Hypertension/drug therapy , Blood Pressure , Blood Pressure Monitoring, Ambulatory , Blood Pressure DeterminationABSTRACT
Hypertension (HYP) is the first cause of death and disability worldwide. In Spain, one in 3 adults was hypertensive in 2010 (62% in those >65 years in 2017). Despite improvement in HYP management over time, only half of treated hypertensive patients are adequately controlled, which translates in 30,000 annual cardiovascular deaths attributable to HYP. Among modifiable determinants of lack of blood pressure (BP) control in Spain are: (a) the white-coat phenomenon (accounting for 20-50% of apparent lack of control) due to not using ambulatory BP monitoring (ABPM, use ≈20%) or self-measurement of home BP (HBPM, use ≈60%) for confirming HYP diagnosis; (b) insufficient patients adherence to BP-lowering lifestyles (e.g., only 40% of hypertensive patients have a sodium intake <2.4g/day, or follow a weight reduction advice), and (c) use of drug monotherapy (≈50% currently), usually insufficient to achieve an optimal control. It is necessary to implement strategies to monitor the evolution of the proportion of subjects with HYP with reasonable national update, to promote population's knowledge of their BP figures and of other cardiovascular risk factors, to improve the degree of HYP control and vascular risk in Spain.
Subject(s)
Hypertension , Adult , Blood Pressure , Blood Pressure Monitoring, Ambulatory , Humans , Hypertension/diagnosis , Hypertension/drug therapy , Hypertension/epidemiology , Spain/epidemiologyABSTRACT
The pandemic caused by coronavirus SARS-CoV-2 (COVID-19) has forced, in many cases, to replace face-to-face consultation with the telematic consultation, in order to reduce the risk of contagion associated with the presence of patients in health centres. This change may represent an opportunity for a different and more effective communication between professionals and patients, allowing better accessibility to medical care and more systematic and comprehensive approach to patients with hypertension and cardiovascular risk. However, organisational tools are needed to facilitate communication between patients and professionals, specifically with the exchange of clinical data by remote monitoring of variables associated with hypertension and cardiovascular risk (blood pressure, weight, height, blood tests ), and allow monitoring of adherence to treatments, lifestyles and risk factors. It would be desirable for this to be carried out by multidisciplinary teams, both from primary care, hospital and community pharmacy, with an adequate coordination of care. This document of the Spanish Society of Hypertension (SEH-LELHA) tries to give the keys to improve the quality of care of telematic consultations of patients with hypertension and cardiovascular risk, provide basic criteria of telematic or face to face attention and systematise their content. Likewise, the follow-up criteria are proposed by the different professionals.