Table of Contents:
- Definition/classification of hypertension
- Hypertension treatment guidelines
Definition/Classification of Hypertension
The table below draws a comparison on the classification of hypertension including the definition of hypertension from the National Institute of Clinical Excellence (NICE), European Society of Cardiology/European Society of Hypertension (ESC/ESH) and American College of Cardiology/American Heart Association (ACC/AHA).
|
NICE |
ESC/ESH |
ACC/AHA |
|---|---|---|
|
Stage 1 Hypertension Clinic blood pressure: 140/90-159/99 mmHg and subsequent ABPM daytime/HBPM average blood pressure: 135/85-149/94 mmHg |
Grade 1 Hypertension Systolic 140-159 mmHg and/or Diastolic 90-99 mmHg |
Stage 1 Hypertension Systolic 130–139 mmHg or Diastolic 80–89 mmHg |
|
Stage 2 Hypertension Clinic blood pressure: 160/100-179/119 mmHg and subsequent ABPM daytime/HBPM average blood pressure: ≥150/95 mmHg |
Grade 2 Hypertension Systolic 160-179 mmHg and/or Diastolic 100-109 mmHg |
Stage 2 Hypertension Systolic ≥140 mmHg or Diastolic ≥90 mmHg |
|
Stage 3/Severe Hypertension Clinic blood pressure: Systolic ≥180 mmHg or Diastolic ≥120 mmHg |
Grade 3 Hypertension Systolic ≥180 mmHg and/or Diastolic ≥110 mmHg |
ABPM: Ambulatory blood pressure monitoring; HBPM: Home blood pressure monitoring
Source: 1) National Institute for Health and Care Excellence (NICE). Hypertension in adults: diagnosis and management. 2020. Available at: https://www.nice.org.uk/guidance/ng136 [Accessed on 01/06/2019] 2) Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. J Hypertens 2018;36:1953–2041 3) Whelton PK, Carey RM, Aronow WS, et al. 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. J Am Coll Cardiol. 2018;71:e127-e248.
Hypertension Treatment Guidelines
The links below provide the latest clinical guidelines on the diagnosis and management of hypertension from health organisations and speciality societies.
NICE Clinical Guideline: Hypertension
The NICE updated its clinical guideline in August 2019 on the diagnosis and management of hypertension in adults. The guideline discusses:
- How to make an accurate diagnosis of hypertension,
- How to assess cardiovascular risk and target organ damage,
- The ABCD step approach used in the treatment of hypertension, and
- The recommended lifestyle interventions for hypertension.
Hypertension in adults: diagnosis and managementThis guideline covers identifying and treating primary hypertension (high blood pressure) in people aged 18 and over, including people with type 2 diabetes. It aims to reduce the risk of cardiovascular problems such as heart attacks and strokes by helping healthcare professionals to diagnose hypertension accurately and treat it effectively.
ESC/ESH Clinical Guidelines: Hypertension
The ESC and the ESH updated their clinical guidelines in 2018 on the management of arterial hypertension in adults. These joint clinical guidelines cover:
- The diagnosis of hypertension,
- The antihypertensive drug treatment algorithm,
- Carrying out a cardiovascular disease risk assessment,
- The recommended lifestyle interventions, and
- Hypertension in special patient groups.
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 HypertensionThese 2018 ESC/ESH Guidelines for the management of arterial hypertension are designed for adults with hypertension, i.e. aged ≥18 years. The purpose of the review and update of these Guidelines was to evaluate and incorporate new evidence into the Guideline recommendations. The specific aims of these Guidelines were to produce pragmatic recommendations to improve the detection and treatment of hypertension, and to improve the poor rates of BP control by promoting simple and effective treatment strategies.
ACC/AHA Clinical Guidelines: Hypertension
The ACC/AHA published their clinical guideline in 2017 on management of hypertension in adults. These guidelines are an update of the seventh report of the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure (JNC 7). This guideline addresses key areas such as:
- The method for measuring blood pressure,
- The diagnosis of hypertension,
- Lifestyle interventions,
- Antihypertensive drug treatment including recommendations of initially prescribing a single antihypertensive drug vs combination antihypertensive drugs, and
- The treatment of hypertension in special patients group or patients with comorbidities.
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.The present guideline is intended to be a resource for the clinical and public health practice communities. It is designed to be comprehensive but succinct and practical in providing guidance for prevention, detection, evaluation, and management of high BP.
The National Heart Foundation of Australia’s Hypertension Guidelines
The National Heart Foundation of Australia published its guidelines in 2016 for the management of hypertension in adults. These guidelines provide recommendations:
- For the diagnosis of hypertension,
- Assessing for absolute CVD risk,
- Lifestyle advice,
- Drug treatment of hypertension,
- The treatment of patients with co-morbidities, and
- The treatment of special patient groups.
The National Heart Foundation of Australia’s Guideline for the diagnosis and management of hypertension in adults – 2016 provides updated recommendations on the management of hypertension at a time when knowledge in this area is rapidly changing.These guidelines have been endorsed by Kidney Health Australia, National Stroke Foundation and the High Blood Pressure Research Council of Australia. The Royal Australian College of General Practitioners (RACGP) have recommended the Guideline for approval as an Accepted Clinical Resource.
Hypertension Canada’s Guideline on Hypertension in Adults and Children
Hypertension Canada published its guidelines in 2018 for the diagnosis, risk assessment, prevention and treatment of hypertension in adults and children. These guidelines cover key areas such as making a diagnosis and the assessment of hypertension, lifestyle intervention guidelines and the prescribing of antihypertensive drugs.
Hypertension Canada’s Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults and ChildrenManagement of hypertension in children and adults centres around behavioural changes as well as pharmacotherapy, and is highly informed by individual cardiovascular risk. Hypertension Canada continues to recommend a risk-based approach for treatment thresholds and targets, placing a strong emphasis on cardiovascular risk assessment not only for the purpose of therapeutic decision-making but also to engage and educate patients in risk reduction strategies.
