2020 International Society of Hypertension Global Hypertension Practice Guidelines
To line up with their mission of reducing the global burden of high blood pressure (BP), the International Society of Hypertension (ISH) has put forward guidelines for worldwide clinical practitioners. The author Unger and colleagues (2020) published guidelines under the title “2020 International Society of Hypertension Global Hypertension Practice Guidelines” in the American Heart Association Journal.
Due to the vastness of this guideline, we are going to summarize only on “Blood Pressure Measurement and Diagnosis of Hypertension” this month.
Objective:
To provide evidence-based guidelines for clinical practitioners worldwide
Method:
The guidelines are by experts in accordance with the available evidence and published researches. With an aim of providing an easy-to-understand format for clinicians and health care workers, the guidelines are divided into essential and optimal standards of care.
Recommendations:
Guidelines for office pressure level Measurement:
• Conditions: Quiet space with a comfortable temperature. Avoid smoking before measurements; no caffeine and exercise for thirty minutes; empty bladder; stay sitting and relaxed for 3–5 minutes. Neither patient nor staff ought to speak before, during, and between measurements.
• Positions: Sitting position with arm resting on table with mid-arm at heart level; back supported on the chair; legs uncrossed and feet flat on the ground.
• Device: valid electronic (oscillometric) upper-arm cuff device or else use a calibrated auscultatory device with first Korotkoff sound for systolic pressure level and fifth for diastolic with a low deflation rate.
• Cuff: Size in keeping with the individual’s arm circumference as smaller cuff overestimates and bigger cuff underestimates pressure level. For manual auscultatory devices, the expansive bladder of the cuff should cover 75%–100% of the individual’s arm circumference. For electronic devices use cuffs in keeping with device directions.
• Protocol: At every visit take three measurements with one min between them. Calculate the common of the last two measurements. If the BP of the primary reading is <130/85 mmHg no further measurement is needed.
• Interpretation: pressure level of 2–3 office visits ≥140/90 mmHg indicates cardiovascular disease.
Guidelines for blood pressure measurement plan according to office pressure level:
• Office pressure level (mmHg) <130/85: Remeasure among three years (1 year in those with different risk factors) • Office pressure level (mmHg) of 130–159/85–99: If doable, ensure with out-of-office pressure level measurement (high risk of the white coat or masked hypertension) or else, ensure with continual office visits. • Office pressure level (mmHg) >160/100: ensure within a few days or weeks
Guidelines for Clinical Use of Home Blood Pressure (BP) Monitoring:
• Condition: As for office pressure level (see above)
• Position: As for office BP (see above)
• Device: valid electronic (oscillometric) upper-arm cuff device
• Cuff: Size in keeping with the individual’s arm circumference
• Measurement protocol: 3–7-day watching observation in the morning (before drug intake if treated) and also in the evening before every visit to the health professional; 2 measurements on every occasion after five min sitting rest and one min between measurements; 1–2 measurements per week or month for long-run follow-up of treated cardiovascular disease
• Interpretation: Average home pressure level after excluding readings of the first day ≥135 or 85 mmHg indicates cardiovascular disease.
Guidelines for Clinical Use of 24-Hour Ambulatory Blood Pressure Monitoring (ABPM):
• Condition: Routine working day
• Position: Avoid strenuous activity. Arm still and relaxed throughout every measurement.
• Device: valid electronic (oscillometric) upper-arm cuff device
• Cuff: Size in keeping with the individual’s arm circumference
• Measurement protocol: 24-hour observation at 15–30 min intervals throughout daytime and nighttime; a minimum of twenty valid daytime and seven nighttime BP readings are needed. If less, repeat the test.
• Interpretation: 24-hour ambulatory blood pressure ≥130/80 mmHg indicates cardiovascular disease (primary criterion); Daytime (awake) ambulatory blood pressure ≥135/85 mmHg and nighttime (asleep) ≥120/70 mmHg indicates hypertension.
Guidelines for White Coat and Masked Hypertension:
• An individual with White Coat Hypertension has elevated BP only in the office. These individuals are at intermediate cardiovascular risk between normotensives and sustained hypertensives. The diagnosis should be confirmed by the continual office and out-of-office BP measurements. Lifestyle modifications should be encouraged without any drug treatment in patients with low cardiovascular risk and no hypertension-mediated organ damage (HMOD).
• An individual with Masked Hypertension has elevated BP out-of-office. These individuals are at the same risk of cardiovascular events like sustained hypertensives. The diagnosis should be confirmed by the continual office and out-of-office BP measurements. These individuals may require drug treatment with an aim to normalize out-of-office BP.
Image Credit : Woman photo created by freepik – www.freepik.com