Management of Stage 1 Hypertension in Adults with a Low 10-Year Risk for Cardiovascular Disease: Filling a Guidance Gap A Scientific Statement from the American Heart Association
There have been many evidence-based guidelines to support High blood pressure (BP) treatment. However, there are no guidelines for some situations due to lack of trials. Daniel W. Jones and a colleague published in the American Heart Association journal under title “Management of Stage 1 Hypertension in Adults with a Low 10-Year Risk for Cardiovascular Disease: Filling a Guidance Gap”. The summary of this study is given below:
To provide guidelines complementary to the 2017 Hypertension Clinical Practice Guidelines for the patient with special situations.
The guidelines were developed in complementary to the 2017 Hypertension Clinical Practice Guidelines. The target for this guideline was patients that had untreated stage 1 hypertension with a 10-year risk for atherosclerotic cardiovascular disease of <10% who fails to meet the systolic BP/diastolic goal after six months of guideline-recommended lifestyle therapy. The statements in this paper are through evidence from sources other than event-based randomized controlled clinical trials. The therapy options are provided by clinicians.
Similar to previous guidelines, patients with stage 1 hypertension who have an estimated 10-year ASCVD risk <10% should be advised with nonpharmacological (lifestyle) therapy along with repeat BP assessment within 3 to 6 months. Patients should be motivated for lifestyle change therapy for achieving BP goals without the use of medication.
The addition of medication among the 4 classes recommended in the 2017 guideline should be considered if the BP goal of <130/80 mmHg is not achieved by lifestyle therapy within 6 months in all patients with stage 1 hypertension.
Original medication should be reconsidered before continuing with antihypertensive drugs or lifestyle therapy for patients who were diagnosed with hypertension during adolescence or childhood.
In young adults diagnosed with stage 1 hypertension but are not controlled with lifestyle therapy and have a family history of premature CVD, a personal history of premature birth, or a history of hypertension during pregnancy should be treated under special consideration with antihypertensive medication.
Adherence issues should be carefully attended for young adults with stage 1 hypertension as recommended in the 2017 Hypertension Clinical Practice Guidelines.
10-year risk should be assessed every 4 to 6 years in patients with a 10-year risk <10% as a primary preventive measure for CVD.
Due to the absence of randomized controlled trial data, considerations in this paper are based primarily on observational data. Hence, the authors suggest using clinical judgment while considering medication for these patients.
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