Purpose of the guidelines
To fulfill the mission of "improving the global burden of elevated blood pressure", the international society of hypertension (ISH) has developed a practical guideline for the management of hypertension for adults aged 18 and above. Referring to the latest guidelines published recently and strictly reviewed, the ISH Guidelines Committee has condensed the specific contents with evidence-based support and has customized two management standards of "basic standard" and "best standard" in practical form, so that clinicians, nursing staff, and community health workers can adopt them in the case of lack of resources or sufficient resources.
The best standard refers to the evidence-based management standard stated in recent guidelines and summarized in this paper. The basic standard is set in consideration of the fact that the best standard is not always feasible. Therefore, the basic standard is actually the minimum standard. Since the standard is the most practical one, it can not be distinguished from the most basic one.
Definition of hypertension
In line with most mainstream guidelines, hypertension was defined as the office systolic blood pressure ≥ 140 mmHg and/or the consulting room diastolic blood pressure ≥ 90 mmHg after repeated measurements. Table 1 shows the classification of hypertension based on the office blood pressure, and table 2 provides the criteria for defining ambulatory blood pressure and home blood pressure for hypertension; these blood pressure definitions apply to all adults (> 18 years old). This classification of blood pressure aims to match the treatment with the corresponding blood pressure level.
Cardiovascular risk factors
Cardiovascular risk assessment should be carried out in all patients with hypertension. A simple scoring scale based on blood pressure level and other risk factors can be simplified according to the method proposed in ESC / ESH guidelines.
Other risk factors
➤ high blood uric acid (S-UA) is common in patients with hypertension. Symptomatic patients [gout and S-UA > 6 mg/dl (0.357mmol / L)] should adjust their diet and use drugs that affect urate (Losartan, Bates, atorvastatin) or drugs that reduce urate.
➤ it must be considered that patients with hypertension complicated with chronic inflammatory disease, COPD, mental illness, unsafe or stressed lifestyle have increased cardiovascular risk and need to effectively control blood pressure.
Treatment of hypertension: improving lifestyle
Improving lifestyle is also the first line of antihypertensive treatment. Improving lifestyle can also enhance the efficacy of antihypertensive therapy. Specific measures to improve lifestyle include the following aspects
Drug treatment of hypertension
The drug treatment strategy recommended here (Figure 2-4) is basically consistent with the latest American and European guidelines.