Neue US-Hypertonie-Empfehlung 2017

Ganz aktuell finden wir die neusten Empfehlungen zur Definition einer arteriellen Hypertonie aus den USA von verschiedenen Fachgesellschaften (ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA). Eine Übersicht zu den US-amerikanischen Empfehlungen finden sich hier:

2017 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. (PDF


In einer Leitlinien-Synopsis werden die Hauptempfehlungen zusammengefasst:

Cifu AS et al. Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. JAMA Published Online November 20, 2017 (Link)


Diagnosis

a. Blood pressure should be categorized as normal (<120/80mmHg), elevated (120-129/<80mmHg), stage 1 hypertension (130-139/80-89mmHg), or stage 2 hypertension (140/90mmHg) (strong recommendation; moderate-quality evidence).

b. Out-of-office blood pressure measurements are recommended to confirm the diagnosis of hypertension and for titration of blood pressure-lowering medication in conjunction with telehealth counseling or clinical interventions (strong recommendation; high-quality evidence).

2. Initiating therapy

a. Many nonpharmacologic interventions that are effective in lowering blood pressure  are recommended for people with elevated blood pressure or hypertension (strong recommendation; high-quality evidence).

b. Blood pressure–lowering medication is recommended for patients with clinical cardiovascular disease or an estimated 10-year atherosclerotic cardiovascular disease risk of 10% or higher who have a systolic blood pressure of 130 mmHg or higher or a diastolic blood pressure of 80 mmHg or higher (strong recommendation; high-quality evidence [for systolic blood pressure] and expert opinion [for diastolic blood pressure]).

c. For patients with no history of cardiovascular disease and an atherosclerotic cardiovascular disease risk of less than 10%, blood pressure-lowering medication is recommended for patients who have an systolic blood pressure of 140 mmHg or higher or a diastolic blood pressure of 90 mmHg or higher (strong recommendation; low-quality evidence).

3. Management

a. In patients with cardiovascular disease or atherosclerotic cardiovascular disease event risk of 10% or higher, a blood pressure target of less than 130/80mmHg is recommended (strong recommendation; moderate-quality evidence [for systolic blood pressure] and expert opinion [for diastolic blood pressure]). A blood pressure target of less than 130/80 mmHg may also be reasonable in low-risk patients (weak recommendation; moderate-quality evidence [for systolic blood pressure] and expert opinion [for diastolic blood pressure]).

b. In patients warranting pharmacotherapy, thiazide diuretics, calcium channel blockers, and angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers are recommendedas first-lineagents (strong recommendation; high-quality evidence).

c. Patients with stage 2 hypertension and an average blood pressure of more than 20/10mmHg above their blood pressure target should begin therapy with 2 first-line agents of different classes (strong recommendation; expert opinion).


Kritische Worte wurden auch umgehend publiziert, z.B. in diesem Artikel des deutschen Ärzteblatts: PDF
Hier wird beispielsweise ausgeführt: „In den USA hingegen steigt die Zahl der Hochdruckpatienten auf „einen Streich“ von etwa 72 auf 103 Millionen.“


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