Cardiometabolic Chronicle

HYPERTENSION which course of treatment to follow?

High blood pressure is a dangerous medical condition that eventually leads to cardiac disorders and stroke if not regulated on time, and around 75 million Americans (~one in every three adults) are afflicted with hypertension at present, according to the Centers for Disease Control and Prevention (CDC). The American College of Cardiology/American Heart Association (ACC/AHA) 2017 guidelines has categorized blood pressure (BP) into the following groups: <120/80 mm Hg as normal blood pressure, 120-129/80 mm Hg as elevated BP, 130-139 mm Hg systolic pressure or 80-89 mm Hg diastolic pressure as stage-I hypertension, and 140/90 mm Hg as stage-II hypertension. In addition to re-categorizing the BP subdivisions, greater emphasis rests on out-of-office BP measurement for accurate hypertension monitoring and for prescribing required medication.1-4

With myriad factors causing the incidence and progression of high blood pressure, including several lifestyle-related risks- obesity, inactivity, improper diet, stress and alcohol; pre-existing medical conditions- diabetes, pre-hypertension and chronic kidney disease (CKD); and othersfamily history, race and gender; hypertension is considered a silent killer. In terms of disease management, lifestyle modification is essential; patients are advised to maintain a healthy diet (heart-friendly, sodium restricted, and lipid- lowering), exercise regularly, and monitor BP constantly. High BP is generally associated with high sodium and subsequent fluid retention in the body, that can lead to swollen lower extremities and hardening of the heart arteries; advanced cases of hypertension can show signs of headache, dizziness, shortness of breath, and eye problems. Moreover, prolonged hypertension can cause more serious ailments that include retinopathy, cardiac failure, cerebral stroke, or renal dysfunction.5-7



  1. Vijayakumar, Shilpa, Javed Butler, and George L. Bakris. “Barriers to guideline mandated renin– angiotensin inhibitor use: focus on hyperkalaemia.” European Heart Journal Supplements 21. Supplement_A (2019): A20-A27.
  2. Burnier, Michel, George Bakris, and Bryan Williams. “Redefining diuretics use in hypertension: why select a thiazide-like diuretic?.” Journal of Hypertension 37.8 (2019): 1574-1586.
  3. Bakris, George. “Similarities and differences between the ACC/AHA and ESH/ESC guidelines for the prevention, detection, evaluation, and management of high blood pressure in adults: a perspective.” Circulation Research 124.7 (2019): 969-971.
  4. Whelton, Paul K., 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: a report of the American College of Cardiology/ American Heart Association Task Force on Clinical Practice Guidelines.” Journal of the American College of Cardiology 71.19 (2018): e127-e248.
  5. Konstantinidis, Lazaros, and Yan Guex-Crosier. “Hypertension and the eye.” Current Opinion in Ophthalmology 27.6 (2016): 514-521.
  6. Pinho-Gomes, Ana Catarina, and Kazem Rahimi. “Management of blood pressure in heart failure.” Heart 105.8 (2019): 589-595.
  7. Palmer, Biff F. “Renal dysfunction complicating the treatment of hypertension.” New England Journal of Medicine 347.16 (2002): 1256-1261.
  8. Mann, Johannes FE, and Karl F. Hilgers. “Renin-angiotensin system inhibition in the treatment of hypertension.” UpToDate (2016).
  9. Yang, Yang, and Huilan Xu. “Comparing six antihypertensive medication classes for preventing new-onset diabetes mellitus among hypertensive patients: a network meta-analysis.” Journal of Cellular and Molecular Medicine 21.9 (2017): 1742-1750.
  10. Carey, Robert M., and Paul K. Whelton. “Prevention, detection, evaluation, and management of high blood pressure in adults: synopsis of the 2017 American College of Cardiology/American Heart Association hypertension guideline.” Annals of Internal Medicine 168.5 (2018): 351-358.
  11. Wright, Jackson T., et al. “Outcomes in hypertensive black and nonblack patients treated with chlorthalidone, amlodipine, and lisinopril.” JAMA 293.13 (2005): 1595-1608.
  12. Olde Engberink, Rik HG, et al. “Effects of thiazide- type and thiazide-like diuretics on cardiovascular events and mortality: systematic review and meta-analysis.” Hypertension 65.5 (2015): 1033- 1040.
  13. Barbos, Eduardo, et al. “Guidelines on the management of arterial hypertension and related comorbidities in Latin America.” Journal of Hypertension 35.8 (2017): 1529-1545.


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