![]() 10 New developments include redefining hypertension, 2 initiating treatment with a single pill combination therapy, 1 advising wider out-of-office BP measurement, 2, 10 and lower BP targets. Recently, we have observed a recent flurry of updated evidence-based guidelines arising mainly from high-income regions and countries, including the United States of America, 2 Europe, 1 United Kingdom, 8 Canada 9 and Japan. To improve the management of hypertension, the ISH has published in 2014 with the American Society of Hypertension, Clinical Practice Guidelines for the Management of Hypertension in the Community (See Section 11: Resources). 4, 5 It is therefore critical that population-based initiatives are applied to reduce the global burden of raised BP, such as salt-reduction activities and improving the availability of fresh fruit and vegetables. 6, 7ĭespite several initiatives, the prevalence of raised BP and adverse impact on cardiovascular morbidity and mortality are increasing globally, irrespective of income. In response to poor global awareness for hypertension (estimated 67% in HIC and 38% in LMIC), 4 the ISH launched a global campaign to increase awareness of raised BP, namely the May Measurement Month initiative. The large disparities in the regional burden of hypertension are accompanied by low levels of awareness, treatment and control rates in LMIC, when compared to HIC. ![]() 4 However, BP trends show a clear shift of the highest BPs from high-income to low-income regions, 5 with an estimated 349 million with hypertension in HIC and 1.04 billion in LMICs. 3 When reviewing global figures, an estimated 1.39 billion people had hypertension in 2010. Raised BP remains the leading cause of death globally, accounting for 10.4 million deaths per year. Every effort should be made to achieve essential standards of care to reduce hypertension-induced cardiovascular morbidity and mortality. Although challenging to implement, these guidelines may aid in local initiatives to motivate policy changes and serve as an instrument to drive local improvements in standards of care. The Guidelines Committee is also aware that some recommended essential standards may not be feasible in low resource settings, for example, out-of-office BP measurements, the requirement of multiple visits for the diagnosis of hypertension, or advising the use of single pill combination therapy. In the Guidelines, differentiation between optimal and essential standards were not always possible, and were made in sections where it was most practical and sensible. To allow specification of essential standards of care for low resource settings, the Committee was often confronted with the limitation or absence in clinical evidence, and thus applied expert opinion. Hence essential standards refer to minimum standards of care. Herein optimal care refers to evidence-based standard of care articulated in recent guidelines 1, 2 and summarized here, whereas standards recognize that standards would not always be possible. 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. The ISH Guidelines Committee extracted evidence-based content presented in recently published extensively reviewed guidelines and tailored and standards of care in a practical format that is easy-to-use particularly in low, but also in high resource settings – by clinicians, but also nurses and community health workers, as appropriate. To align with its mission to reduce the global burden of raised blood pressure (BP), the International Society of Hypertension (ISH) has developed worldwide practice guidelines for the management of hypertension in adults, aged 18 years and older. Customer Service and Ordering Information. ![]() Stroke: Vascular and Interventional Neurology.Journal of the American Heart Association (JAHA).Circ: Cardiovascular Quality & Outcomes. ![]()
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