The guideline update by clinical experts was facilitated by the National Heart Foundation of Australia and is summarised in today’s issue of the Medical Journal of Australia.
If clinic blood pressure is elevated, offering confirmation with out-of-clinic measures, such as ambulatory and home blood pressure assessment, are now recommended, as they are stronger predictors of outcome. The benefit of treatment in patients with uncomplicated mild hypertension was confirmed in a 2015 meta-analysis.
A major change from earlier guidelines is the recommendation for a lower target blood pressure (≤ 120 mmHg) in high risk patients. This change follows a trial, published in 2015, in which benefit (improved cardiovascular outcomes) was demonstrated in a selected high risk population, but with some increase in treatment-related adverse effects.
Dr Tanya Medley, Senior Research Officer at Murdoch Children's explains that the guidelines present this new and significant evidence to assist general physicians in making informed decisions together with their patients on blood pressure targets and treatment strategies.
“While the new blood pressure targets are likely to gain attention, this guideline also emphasises the importance of attaining accurate blood pressure measures and the beneficial effect that lifestyle interventions have on reducing blood pressure and cardiovascular risk in Australians”, said Medley.
In an accompanying editorial in the MJA, Professor Garry Jennings from the Baker IDI Heart and Diabetes Institute and the National Heart Foundation of Australia commended the new guidelines, commenting that they were “adapted for Australian conditions at a time when knowledge of the field has been moving rapidly”.
Professor Jennings wrote that the new guidelines deal with the paradox that most people who have heart attacks or strokes caused by elevated blood pressure do not meet the conventional definition of hypertension.
He admitted that there were holes in the evidence base that were not helpful for clinicians needing advice for particular patients.
“In future, we need to move the emphasis from large tomes written by expert groups to providing decision support individualised to the patient,” he wrote.
The Medical Journal of Australia is a publication of the Australian Medical Association.