Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. Urapidil and nitroprusside are additional suitable options. The guideline is formatted as two clinical algorithms and 28 evidence-based recommendations. Hypertension 2017; 70:897–890. Spironolactone versus clonidine as a fourth-drug therapy for resistant hypertension: The ReHOT Randomized Study (Resistant Hypertension Optimal Treatment). Treating hypertension has a major impact on reducing the risk of incident HF and HF hospitalization. Figure 2. Consider screening patients for secondary causes as appropriate (refer to Section 10.2). The Journal of Clinical Hypertension 2014; 16(1):14–26]. Interventions to improve medication adherence in hypertensive patients: systematic review and meta-analysis. British and Irish Hypertension Society: https://bihsoc.org/bp-monitors/, German Hypertension Society: https://www.hochdruckliga.de/messgeraete-mit-pruefsiegel.html, Hypertension Canada: https://hypertension.ca/hypertension-and-you/managing-hypertension/measuring-blood-pressure/devices/. Triglyceride-rich lipoproteins and atherosclerotic cardiovascular disease: new insights from epidemiology, genetics, and biology. Other organs/systems: Enlarged kidneys, neck circumference >40 cm (obstructive sleep apnea), enlarged thyroid, increased body mass index (BMI)/waist circumference, fatty deposits and coloured striae (Cushing disease/syndrome). II. Evaluate adherence to antihypertensive treatment as appropriate at each visit and prior to escalation of antihypertensive treatment. Intravenous therapy is usually required. Phentolamine, a competitive alpha-receptor blocking agent and clonidine, a centrally sympatholytic agent with additional sedative properties are useful if additional BP-lowering therapy is required. organization. When compared to Western populations, East Asian people present a higher prevalence of stroke (particularly hemorrhagic stroke) and nonischemic HF.1. Risk factors: Personal history of CVD (myocardial infarction, heart failure [HF], stroke, transient ischemic attacks [TIA], diabetes, dyslipidemia, chronic kidney disease [CKD], smoking status, diet, alcohol intake, physical activity, psychosocial aspects, history of depression). BP should be lowered if ≥140/90 mm Hg and treated to a target <130/80 mm Hg (<140/80 in elderly patients).1, RAS blockers, CCBs, and diuretics are first-line drugs.1, Lipid-lowering treatment is mandatory with a LDL-C target <70 mg/dL (1.8 mmol/L) in ischemic stroke.1, Antiplatelet treatment is routinely recommended for ischemic stroke, but not hemorrhagic stroke, and should be carefully considered in patients with hemorrhagic stroke only in the presence of a strong indication.1, Hypertension is a risk factor for the development of HF with reduced ejection fraction (HFrEF), and with preserved ejection fraction (HFpEF). The management of primary aldosteronism: case detection, diagnosis, and treatment: An Endocrine Society clinical practice guideline. Japanese Society of Hypertension: http://www.jpnsh.jp/com_ac_wg1.html. In Africa only 25% of countries have hypertension guidelines13 and in many instances these guidelines are adopted from those of high-income regions. It is important to note that the individual effect of these substances on BP can be highly variable with greater increases noted in the elderly, those with higher baseline BP, using antihypertensive therapy or with kidney disease. Serum triglyceride lowering should be considered if >200 mg/dL (2.3 mmol/L) particularly in patients with hypertension and DM. ), Neurovascular Hypertension & Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia (M.N. Journal of the American Heart Association, 2020 International Society of Hypertension Global Hypertension Practice Guidelines, https://doi.org/10.1038/s41440-019-0284-9, https://doi.org/10.1093/eurheartj/ehz486], https://apps.who.int/iris/bitstream/handle/10665/260424/WHO-NMH-NVI-18.4-eng.pdf;jsessionid=7AC6EC215FEB390CBD93898B69C4705C?sequence=1, https://tools.acc.org/ldl/ascvd_risk_estimator/index.html#!/calulate/estimator/, https://www.world-heart-federation.org/cvd-roadmaps/whf-global-roadmaps/hypertension/, https://www.hochdruckliga.de/messgeraete-mit-pruefsiegel.html, https://hypertension.ca/hypertension-and-you/managing-hypertension/measuring-blood-pressure/devices/, https://www.idf.org/e-library/consensus-statements/60-idfconsensus-worldwide-definitio-nof-the-metabolic-syndrome.html, Gut Microbiota and Host Plasma Metabolites in Association with Blood Pressure in Chinese Adults, Starting Antihypertensive Drug Treatment With Combination Therapy. Prognosis of white-coat and masked hypertension: International Database of HOme blood pressure in relation to Cardiovascular Outcome. Ambiguities in the guidelines for the management of arterial hypertension: Indian perspective with a call for global harmonization. BP should be lowered if ≥140/90 mm Hg and treated to a target <130/80 mm Hg but >120/70 mm Hg. Preeclampsia. Contraindicated: RAS blockers (ACE-I, ARB, direct renin inhibitors [DRI]) due to adverse fetal and neonatal outcomes. The 2020 ISH Global Hypertension Practice Guidelines were developed by the ISH Hypertension Guidelines Committee based on evidence criteria, (1) to be used globally; (2) to be fit for application in low and high resource settings by advis-ing on essential and optimal standards; and (3) to be concise, simplified, and easy to use. The treatment strategy should include an RAS inhibitor (and a CCB and/or thiazide-like diuretic). The authors are grateful to Elena Kaschina and Michél Strauss-Kruger for their help in preparing and editing this article. Kidneys: Kidney damage can be a cause and consequence of hypertension and is best assessed routinely by simple renal function parameters (serum creatinine and eGFR) together with investigation for albuminuria (dipstick or urinary albumin creatinine ratio [UACR]) in early morning spot urine). Nitroglycerin and nitroprusside are specifically useful in hypertensive emergencies including the heart and the aorta. Pharmacological treatment of hypertension: general scheme. ), London School of Hygiene and Tropical Medicine, United Kingdom (D.P. Expert recommendations on the management of hypertension in patients with ovarian and cervical cancer receiving bevacizumab in the UK. CCBs and alpha1-blockers should be used with care in patients with orthostatic hypotension (eg, SRIs). The association between consistent licorice ingestion, hypertension and hypokalaemia: a systematic review and meta-analysis. Multiple Risk Factor Intervention Trial Research Group. In patients with resistant hypertension, investigations for secondary hypertension should generally be preceded by exclusion of pseudoresistant hypertension and drug/substance-induced hypertension. ESC Clinical Practice Guidelines aim to present all the relevant evidence to help physicians weigh the benefits and risks of a particular diagnostic or therapeutic procedure on Arterial Hypertension. EASL recommendations on treatment of Hepatitis C 2020. Establishing international blood pressure references among nonoverweight children and adolescents aged 6 to 17 years. This guideline covers identifying and treating primary hypertension (high blood pressure) in people aged 18 and over, including people with type 2 diabetes. It also includes advice for women with hypertension who wish to conceive and women who have had a pregnancy complicated by hypertension. Table 9. Email, From the CARIM – School for Cardiovascular Diseases, Maastricht University, the Netherlands (T.U. Figure 4. Symptoms/signs of hypertension/coexistent illnesses: Chest pain, shortness of breath, palpitations, claudication, peripheral edema, headaches, blurred vision, nocturia, hematuria, dizziness. A similar strategy was followed concerning the selection of external reviewers with particular consideration of representatives from LMICs. The guideline describes the critical decision points in the Diagnosis and Management of Hypertension in Primary Care and provides clear and comprehensive evidence based recommendations incorporating current information and practices for practitioners throughout the DoD and VA Health Care systems. Figure 6. The blood pressure-lowering effect of a single bout of resistance exercise: a systematic review and meta-analysis of randomised controlled trials. The treatment should include a statin in primary prevention if LDL-C >70 mg/dL (1.8 mmol/L) (diabetes with target organ damage) or >100 mg/dL (2.6 mmol/L) (uncomplicated diabetes). Task Force of the Latin American Society of Hypertension. 3. Symptoms suggestive of secondary hypertension: Muscle weakness/tetany, cramps, arrhythmias (hypokalemia/primary aldosteronism), flash pulmonary edema (renal artery stenosis), sweating, palpitations, frequent headaches (pheochromocytoma), snoring, daytime sleepiness (obstructive sleep apnea), symptoms suggestive of thyroid disease (see Section 10 for full list of symptoms). The recommended patient management according to office BP levels is presented in Table 4. Impact of the 2017 American College of Cardiology/American Heart Association blood pressure guidelines on the next blood pressure guidelines in Asia. Customer Service BP should be lowered as in the general population, preferentially with RAS-inhibitors and diuretics with a lesser rate of pharmacological interactions under antidepressants. 4. Effects of high-intensity interval training versus moderate-intensity continuous training on blood pressure in adults with pre-to established hypertension: a systematic review and meta-analysis of randomized trials. Avoid CCBs if orthostatic hypotension (SRIs), • Proteinuria, hematuria, leukocyturia on dipstick urine analysis, • Symptoms of hypokalemia (muscle weakness, muscle cramps, tetany). If available, lipid profile and fasting glucose. Other presentations of hypertensive emergencies include severe BP elevation associated with cerebral hemorrhage, acute stroke, acute coronary syndrome, cardiogenic pulmonary edema, aortic aneurysm/dissection, and severe preeclampsia and eclampsia. Ankle-brachial index: Peripheral (lower extremity) artery disease. ), Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Perth (M.S. Angiotensin receptor-neprilysin inhibitor (ARNI; sacubitril-valsartan) is indicated for the treatment of HFrEF as an alternative to ACE inhibitors or ARBs also in hypertensive populations. Seasonal variation in blood pressure: evidence, consensus and recommendations for clinical practice. Patients with hypertension are often asymptomatic, however specific symptoms can suggest secondary hypertension or hypertensive complications that require further investigation. They were critically reviewed and evaluated by numerous external hypertension experts from HIC and LMIC with expertize in the optimal management of hypertension and management in resource-constraint settings. Flynn JT, Kaelber DC, Baker-Smith CM, et al. In pulmonary edema: nitroglycerin intravenous infusion. Underlying diseases should be effectively treated by reducing inflammation and by avoiding high doses of NSAIDs. Lifestyle changes are recommended (smoking cessation, diet and exercise). Kidneys/renal artery and adrenal imaging: Ultrasound/renal artery Duplex; CT-/MR-angiography: renal parenchymal disease, renal artery stenosis, adrenal lesions, other abdominal pathology. If their total cardiovascular risk is low and there is no hypertension-mediated organ damage (HMOD), drug treatment may not be prescribed. This site uses cookies. 1-800-242-8721 Dong Y, Ma J, Song Y, Dong B, et al. RAS blockers, beta-blockers irrespective of BP levels with or without calcium channel blockers (CCBs) are first-line drugs in hypertensive patients.1, Lipid-lowering treatment with an LDL-C target <55 mg/dL (1.4 mmol/L).89, Antiplatelet treatment with acetyl salicylic acid is routinely recommended.1, Hypertension is the most important risk factor for ischemic or hemorrhagic stroke.90. Systematic review: antihypertensive drug therapy in patients of African and South Asian ethnicity. Please switch auto forms mode to off. Although distinction between low and high resource settings often refers to high (HIC) and low- and middle-income countries (LMIC), it is well established that in HIC there are areas with low resource settings, and vice versa. This reflects the rapid evolution of knowledge in hypertension driven by major outcome trials for which there were a few since the last edition 5 years ago. This is despite the fact that a difference in BP of 20/10 mm Hg is associated with a 50% difference in cardiovascular risk.68, The pharmacological treatment strategies recommended here (Figures 2–4) are largely compatible with those made in the most recent US2 and European guidelines.1,8. Office BP measurement following general guidelines. BP should be lowered as in the general population, preferentially with RAS-inhibitors (evidence of an overactive RAAS)100 and CCBs. Avoid atenolol, propranolol, nifedipine (high concentration in milk). Circulation 2016; 133:398–408. Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids. Traditional herbal medicine use among hypertensive patients in sub-Saharan Africa: a systematic review. May Measurement Month 2018: a pragmatic global screening campaign to raise awareness of blood pressure by the International Society of Hypertension. RAS blockers, beta-blockers, and mineralocorticoid receptor antagonists are all effective in improving clinical outcome in patients with established HFrEF, whereas for diuretics, evidence is limited to symptomatic improvement.1 CCBs are indicated on in case of poor BP control. Blood pressure assessment in adults in clinical practice and clinic-based research: JACC scientific expert panel. Secondary arterial hypertension: when, who, and how to screen? The type of acute HMOD is the main determinant of the preferred treatment choice. High rates of non-adherence to antihypertensive treatment revealed by high-performance liquid chromatography-tandem mass spectrometry (HP LC-MS/MS) urine analysis. Air pollution exposure and blood pressure: an updated review of the literature. BP should be lowered as done in the general population, preferentially with RAS-inhibitors (ARB, ACE-I) and CCBs.97, Statins are the lipid-lowering treatment of choice with or without ezetimibe and/or PCSK9 inhibitor (in the optimal setting).98. HYPERTENSION 2020: HIGHLIGHTS The Hypertension Canada Guidelines are the nation’s clinical practice guidelines for the management of hypertension. Diagnostic and Clinical Tests 1337, Section 5. First choices: methyldopa, beta-blockers (labetalol), and dihydropyridine-calcium channel blockers (DHP-CCBs) (nifedipine [not capsular], nicardipine). High Impact Papers in Hypertension: Fall 2020. Unauthorized Blood pressure control 1 year after referral to a hypertension specialist. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Arterial hypertension induced by erythropoietin and erythropoiesis-stimulating agents (ESA). Online ahead of print. Roadmap to achieve 25% hypertension control in Africa by 2025. Hypertensive patients have a greater likelihood of salt-sensitivity accompanied with mild obesity. Footnotes: a Hypertension Canada now recommends a salt/sodium intake threshold 2000 mg (5 g of … South Asian populations originating from the Indian subcontinent have a particularly high risk for cardiovascular and metabolic diseases, including CAD and type 2 DM. 2020 Congress of Delegates & FMX; Blogs. The number of comorbidities increases with age, with the prevalence of hypertension and other diseases. Treatment of hypertension in patients with chronic obstructive pulmonary disease (COPD). Fundoscopy should be performed in patients with grade 2 hypertension, ideally by experienced examiners or alternative techniques to visualize the fundus (digital fundus cameras) where available. J Hypertens 2017, 35:1529–1545. Clinical Practice Guidelines for the Management of Hypertension in the Community A Statement by the American Society of Hypertension and the International Society of Hypertension. Evidence from studies support a negative effect of air pollution on blood pressure in the long-term. Hypertension - or elevated blood pressure - is a serious medical condition that significantly increases the risks of heart, brain, kidney and other diseases. Women at high risk (hypertension in previous pregnancy, CKD, autoimmune disease, diabetes, chronic hypertension), or moderate risk (first pregnancy in a woman >40 years, pregnancy interval >10 years, BMI >35 kg/m2, family history of preeclampsia, multiple pregnancies): 75–162 mg aspirin at weeks 12–36. Recommendations for Office Blood Pressure Measurement, Table 4. Patients with hypertension and MS have a high-risk profile. Office blood pressure targets for treated hypertension. : Thoughts from the International Society of Hypertension. The therapeutic strategy must include lifestyle changes, BP control to target and the effective treatment of the other risk factors to reduce the residual cardiovascular risk. Secondary causes can be found in 20%–40% of patients presenting with malignant hypertension118 and appropriate diagnostic workup to confirm or exclude secondary forms is indicated. Possible additional benefits using fenofibrate in low HDL/high triglyceride subgroup. Resistant hypertension in times of changing definitions and treatment recommendations. Current Issue March 2021 Vol 77, Issue 3. Hypertension in Africa Research Team (A.E.S. Classification of Hypertension Based on Office Blood Pressure (BP) Measurement, Table 2. Risks are fetal growth restriction, preterm birth. The treatment strategy should include an angiotensin AT1-receptor blocker (ARB) and CCB and/or diuretic, while beta blockers (ß1-receptor selective) may be used in selected patients (eg, CAD, HF). Overall findings and differences by age for 316,099 white men. A reliable estimate of cardiovascular risk can be obtained in daily practice by including: Other Risk Factors: Age (>65 years), sex (male>female), heart rate (>80 beats/min), increased body weight, diabetes, high LDL-C/triglyceride, family history of CVD, family history of hypertension, early-onset menopause, smoking habits, psychosocial or socioeconomic factors. Acute effects on blood pressure following controlled exposure to cookstove air pollution in the STOVES Study. This guideline covers diagnosing and managing hypertension (high blood pressure), including pre-eclampsia, during pregnancy, labour and birth. Outline of Evidence-Based Management of Other Comorbidities and Hypertension, Table 11. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High blood pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy: the Task Force for the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). There may be a drug interaction with CCB under most of the antiretroviral therapies. ), Department of Health Sciences, Boston University Sargent College, MA (R.D.W. J Hypertens 2020; 38:982. Office blood pressure measurement in the 21st century. Brussels: International Diabetes Federation. The choice of antihypertensive treatment is predominantly determined by the type of organ damage. The combined treatment of hypertension and additional cardiovascular risk factors reduces the rate of CVD beyond BP control. Some are based only on European populations, for example, SCORE. 7272 Greenville Ave. ), Hypertension and Metabolic Unit, University Hospital, Favaloro Foundation, Buenos Aires, Argentina (A.R. ), (2) those with resistant hypertension, (3) individuals with sudden deterioration in BP control, (4) hypertensive urgency and emergency, (5) those presenting with high probability of secondary hypertension based on strong clinical clues. J Clin Hypertens 2018; 20:212–214]. Dallas, TX 75231 The diagnosis needs confirmation with repeated office and out-of-office BP measurements. Editors' Picks. Particularly abdominal obesity should be managed. The diagnosis might be made on a single visit, if BP is ≥180/110 mm Hg and there is evidence of cardiovascular disease (CVD).1,2,17,18. Table 1 provides a classification of BP based on office BP measurement, Table 2 provides ambulatory and home BP values used to define hypertension; these definitions apply to all adults (>18 year old). Heart disease and stroke statistics-2019 update: a report From the American Heart Association. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the Management Of Arterial Hypertension of the European Society of Cardiology and the European Society of Hypertension. The state of hypertension care in 44 low-income and middle-income countries: a cross-sectional study of nationally representative individual-level data from 1.1 million adults. The guideline is intended to improve patient outcomes and local management of patients with hypertension.. Disclaimer:This Clinical Practice Guideline is intended for use only as a tool to assist a clinician/healthcare professional and should not be used to replace clinical judgment. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. JAMA Cardiology | JAMA Cardiology Clinical Guidelines … Studies suggest that regular aerobic and resistance exercise may be beneficial for both the prevention and treatment of hypertension. Out-of-office BP measurement is often necessary for the accurate diagnosis of hypertension and for treatment decisions. Hypertensive encephalopathy: Severe BP elevation associated with lethargy, seizures, cortical blindness and coma in the absence of other explanations. Several medications and substances may increase BP or antagonize the BP-lowering effects of antihypertensive therapy in individuals (Table 7). ), Faculty of Medicine, University of New South Wales, Sydney, Australia (A.E.S. ), Centre for Chronic Disease Control, New Delhi, India (D.P. High Blood Pressure in Kids … Similar changes occur in people traveling from places with cold to hot temperature, or the reverse. Masked hypertension may require drug treatment aiming to normalize out-of-office BP.1,2,17–21,25–27. Are the American Heart Association/American College of Cardiology high blood pressure guidelines fit for global purpose? Weber MA, Poulter NR, Schutte AE, et al. ), The George Institute for Global Health, Sydney, Australia (A.E.S.). Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. ), University of Leicester, Department of Cardiovascular Sciences, United Kingdom (F.C. ISH 2020 recommendations (minimum standards of care). Additional investigations when indicated can be undertaken to assess and confirm suspicion of HMOD, coexistent diseases or/and secondary hypertension. Blood Pressure Measurement and Diagnosis of Hypertension 1336, Section 4. Cardiovascular risk of resistant hypertension: dependence on treatment-time regimen of blood pressure-lowering medications. The overall therapeutic goal in patients presenting with hypertensive emergencies is a controlled BP reduction to safer levels to prevent or limit further hypertensive damage while avoiding hypotension and related complications. ESC Clinical Practice Guidelines aim to present all the relevant evidence to help physicians weigh the benefits and risks of a particular diagnostic or therapeutic procedure on Pulmonary Hypertension. Some smaller groups or institutions could benefit from adapting CPGs to their local context, a process that requires high-quality CPGs with few points of conflict in … Ethnic differences in the degree of morning blood pressure surge and in its determinants between Japanese and European hypertensive subjects: data from the ARTEMIS study. Features of Secondary Hypertension, Table 12. ]: These comprehensive and evidence-based guidelines form a complete detailed resource. An estimated 1.13 billion people worldwide have hypertension, most (two-thirds) living in low- and middle-income countries. Statement from the International Society of Hypertension–a global perspective. There is no specific BP threshold to define a hypertensive emergency. Share via: Print; ... A Report of the American College of Cardiology/American Heart Association Task Force on Clinical … Chronic stress has been associated to high blood pressure later in life. Nutrients and nutraceuticals for the management of high normal blood pressure: an evidence-based consensus document. White coat hypertension: These subjects are at intermediate cardiovascular risk between normotensives and sustained hypertensives. Medication adherence in patients with apparent resistant hypertension: findings from the SYMPATHY trial. Is it time to reappraise blood pressure thresholds and targets? Eur Heart J 2020; 41:255–323, https://doi.org/10.1093/eurheartj/ehz486]. A meta-analysis of effects of selective serotonin reuptake inhibitors on blood pressure in depression treatment: outcomes from placebo and serotonin and noradrenaline reuptake inhibitor controlled trials. [Weber MA, Schiffrin EL, White WB et al. Additional investigations may be required and indicated depending on presentation and clinical findings and may be essential in the context: troponins (chest pain), chest x-ray (congestion/fluid overload), transthoracic echocardiogram (cardiac structure and function), CT/MRI brain (cerebral hemorrhage/stroke), CT-angiography thorax/abdomen (acute aortic disease). Hypertension in Sub-Saharan African populations. 2018 European Society of Cardiology/European Society of Hypertension Guidelines [Williams B, Mancia G, Spiering W, et al. In untreated or treated subjects with office BP classified as high-normal BP or grade 1 hypertension (systolic 130–159 mm Hg and/or diastolic 85–99 mm Hg), the BP level needs to be confirmed using home or ambulatory BP monitoring (Table 5).1,2,17,21. High blood pressure typically does not cause symptoms. There is a lack of randomized controlled trial data to provide clear cut guidance on BP targets and times within which these should be achieved. There are also more Malaysian studies quoted which is a testimony of the growing research interest in the topic nationally. J Hypertens 2018; 36(10): 1953–2041. If the difference is >20 mm Hg consider further investigation. Optimize the current treatment regimen including health behavior change and diuretic-based treatment (maximally tolerated doses of diuretics, and optimal choice of diuretic: use of thiazide-like rather than thiazide diuretics, and initiation of loop diuretics for eGFR <30 ml/min/1.73m2 or clinical volume overload).109, Add a low dose of spironolactone as the 4th line agent in those whose serum potassium is <4.5 mmol/L and whose eGFR is >45 ml/min/1.73m2 to achieve BP targets.8,71,110 If spironolactone is contraindicated or not tolerated, amiloride, doxazosin, eplerenone, clonidine, and beta-blockers are alternatives, or any available antihypertensive class not already in use.1,111–114, Resistant hypertension should be managed in specialist centers with sufficient expertize, and resources necessary to diagnose and treat this condition.115. Most recommendations are based on expert consensus. The 2017 American College of Cardiology/American Heart Association Clinical Practice Guideline for High Blood Pressure in Adults. This final update of the EASL Recommendations on Treatment of Hepatitis C series is intended to assist physicians and other healthcare providers, as well as patients and other interested individuals, in the clinical decision-making process, by describing the current optimal management of patients with acute and chronic HCV … Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. Ultrasound of kidneys and adrenals, free plasma metanephrines (if clinical features of pheochromocytoma); Doppler ultrasound of uterine arteries (after 20 weeks of gestation is useful to detect those at higher risk of gestational hypertension, preeclampsia, and intrauterine growth retardation).
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