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Guideline for the diagnosis and management of hypertension in adults — 2016

Genevieve M Gabb, Arduino A Mangoni, Craig S Anderson, Diane Cowley, John S Dowden, Jonathan Golledge, Graeme J Hankey, Faline S Howes, Les Leckie, Vlado Perkovic, Markus Schlaich, Nicholas A Zwar, Tanya L Medley and Leonard Arnolda
Med J Aust 2016; 205 (2): 85-89. || doi: 10.5694/mja16.00526

Summary

The National Heart Foundation of Australia has updated the Guide to management of hypertension 2008: assessing and managing raised blood pressure in adults (updated December 2010).

Main recommendations

  • For patients at low absolute cardiovascular disease risk with persistent blood pressure (BP) ≥ 160/100 mmHg, start antihypertensive therapy.
  • The decision to treat at lower BP levels should consider absolute cardiovascular disease risk and/or evidence of end-organ damage, together with accurate BP assessment.
  • For patients at moderate absolute cardiovascular disease risk with persistent systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg, start antihypertensive therapy.
  • Treat patients with uncomplicated hypertension to a target BP of < 140/90 mmHg or lower if tolerated.

Changes in management as a result of the guideline

  • Ambulatory and/or home BP monitoring should be offered if clinic BP is ≥ 140/90 mmHg, as out-of-clinic BP is a stronger predictor of outcome.
  • In selected high cardiovascular risk populations, aiming for a target of < 120 mmHg systolic can improve cardiovascular outcomes. If targeting < 120 mmHg, close follow-up is recommended to identify treatment-related adverse effects including hypotension, syncope, electrolyte abnormalities and acute kidney injury.

Why the changes have been made

  • A 2015 meta-analysis of patients with uncomplicated mild hypertension (systolic BP range, 140–159 mmHg) demonstrated that BP-lowering therapy is beneficial (reduced stroke, cardiovascular death and all-cause mortality).
  • A 2015 trial comparing lower with higher blood pressure targets in selected high cardiovascular risk populations found improved cardiovascular outcomes and reduced mortality, with an increase in some treatment-related adverse events.

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  • Genevieve M Gabb1,2
  • Arduino A Mangoni3
  • Craig S Anderson4,5
  • Diane Cowley6
  • John S Dowden7
  • Jonathan Golledge8
  • Graeme J Hankey9
  • Faline S Howes1
  • Les Leckie1
  • Vlado Perkovic4
  • Markus Schlaich1
  • Nicholas A Zwar1
  • Tanya L Medley1
  • Leonard Arnolda1

  • 1 Royal Adelaide Hospital, Adelaide, SA
  • 2 University of Adelaide, Adelaide, SA
  • 3 Flinders Medical Centre, Flinders University, Adelaide, SA
  • 4 The George Institute for Global Health, Sydney, NSW
  • 5 Royal Prince Alfred Hospital, Sydney, NSW
  • 6 Princess Alexandra Hospital, Brisbane, QLD
  • 7 Australian Prescriber, Canberra, ACT
  • 8 Queensland Research Centre for Peripheral Vascular Disease, James Cook University, Townsville, QLD
  • 9 University of Western Australia, Perth, WA
  • 10 Menzies Institute for Medical Research, Hobart, TAS
  • 11 Consumer Representative, Melbourne, VIC
  • 12 Monash University, Melbourne, VIC
  • 13 UNSW Australia, Sydney, NSW
  • 14 Murdoch Childrens Research Institute, Melbourne, VIC
  • 15 Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW

Correspondence: genevieve.gabb@sa.gov.au

Acknowledgements: 

We thank Jinty Wilson for her contribution to the development of the guideline.

Competing interests:

Genevieve Gabb has received speaker fees from AstraZeneca. Arduino Mangoni has received speaker fees and/or educational grants from Pfizer, Sanofi-Aventis and Servier, travel and accommodation expenses to attend scientific meetings from AstraZeneca and Sanofi-Aventis, and royalties from Wiley and Sons. Craig Anderson has received travel support and honoraria for stroke lectures from Boehringer Ingelheim and Takeda China and advisory board fees from AstraZeneca and Medtronic, and has provided consultancy to General Electric and expert testimony for Henry Davis York. Jonathan Golledge has been awarded a number of research grants from the National Health and Medical Research Council and the Queensland Government for unrelated research studies. Graeme Hankey does not have stocks, equity, a contract of employment or a named position on a company board with any company or competitor relevant to this article. In the past 3 years, he has received honoraria from AC Immune for chairing the data safety monitoring committee of two clinical trials of vaccines for Alzheimer disease, from Bayer for lecturing about stroke prevention in atrial fibrillation at sponsored scientific symposia, and from Medscape, Web MD for participating in a discussion about stroke prevention in atrial fibrillation for . Faline Howes was a board member of the National Heart Foundation (Tasmania Division) from 2013 to 2015 and is on an ongoing member of the Health Advisory Committee. She is also a member of the High Blood Pressure Research Council of Australia and the International Society of Hypertension and has received speaker fees from MSD. Markus Schlaich has been on steering committees and advisory boards for, and has received speaker fees from, Abbott Pharmaceuticals, Medtronic, AstraZeneca, Novartis, Servier and Boehringer Ingelheim. Vlado Perkovic has provided consultancy to, and has been on steering committees and received speaker fees from, Medtronic, Baxter, Boehringer Ingelheim, Vitae, Johnson and Johnson, Abbott Pharmaceuticals, Servier, Roche, AstraZeneca, Merck and Boehringer Ingelheim. Leonard Arnolda has received speaker fees for meetings sponsored by Merck and Boehringer Ingelheim.

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