Page 5 - hypertension_newsletter7

REFLECTIONS
Hypertension
Hypertension Global Newsletter #7 2024

The 2024 ESC Guidelines, with their more ‘user friendly’ charts
and summary tables, aim to improve the assessment and Hypertension
management of patients with elevated BP and hypertension.

CLICK HERE
TO VIEW A SHORT INTERVIEW WITH
ONE OF THE AUTHORS OF THE CLICK HERE
GUIDELINES, DR. RHIAN TOUYZ (5:44) FOR THE LINK TO FULL ARTICLE

The management of elevated blood pressure in the acute care setting:

A scientific statement from the American Heart Association.
Bress AP, et al. Hypertension. 2024 Aug;81(8):e94-e106.

The American Heart Association (AHA) has developed guidance on managing elevated BP in the acute care setting with its recent
Scientific Statement. They note that whilst there is high-quality evidence to guide the diagnosis and management of elevated BP in
the outpatient setting, there needs to be comparable evidence in the acute care setting, resulting in significant practice variation. This
scientific statement aims to synthesise the available evidence, provide suggestions for best practice based on the available evidence,
identify evidence-based gaps in managing elevated inpatient BP (asymptomatic and hypertensive emergency), and highlight areas
requiring further research.

The authors clarify the definition of elevated inpatient BP, including hypertensive emergency, asymptomatic markedly elevated BP,
and asymptomatic elevated BP. They propose the following terminology: hypertensive emergency (SBP/DBP >180/110–120 mmHg
with evidence of new or worsening target-organ damage), asymptomatic markedly elevated inpatient BP (SBP/DBP >180/110–120
mmHg without evidence of new or worsening target-organ damage), and asymptomatic elevated inpatient BP (SBP/DBP ≥130/80
mmHg without evidence of new or worsening target-organ damage).

They also discuss the patient and hospital factors contributing to elevated BP readings in the acute care setting, including reversible
causes such as acute stress, pain, anxiety, sleep deprivation, and other acute illness-related factors that can raise BP. A careful
inpatient medication review could also identify medications potentially increasing BP.

The AHA proposed an algorithm for the management of elevated BP in the acute care setting based on determining the severity
of elevated BP measurement, identifying and addressing underlying aetiologies, and assessing for new or worsening target-organ
damage to determine whether initiating or modifying antihypertensive medication regimen may be warranted.

TABLE OF CONTENTS