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Hypertension – Treatment Overview

Treatment Overview

The European AIDS Clinical Society (EACS) recommends hypertension diagnosis and management as part of an overall approach to managing modifiable cardiovascular (CV) risk factors.1

Lifestyle modifications and pharmacotherapy

Depending on the severity of hypertension, presence of risk factors, target organ disease, and/or associated clinical conditions, pharmacotherapy may be needed, as well as lifestyle modification. 


Table 1. Goals of treatment.1

  HIV-positive patient group
Blood pressure target (mmHg) Diabetic, prior cardiovascular
disease or chronic kidney disease
with proteinuria
All other patients
Systolic <130 <140
Diastolic <80 <90

Reproduced with permission from the European AIDS Clinical Society Guidelines. Version 6.0.


Follow up and adherence

  • Once pharmacotherapy is initiated for hypertension, frequent visits (possibly monthly) will be needed to modify the treatment regimen in relation to blood pressure (BP) changes and goals, and appearance of side effects.2,3
    • More frequent visits may be necessary for patients with stage 2 hypertension and/or comorbidities, such as heart failure and diabetes.3

       
  • Follow-up visits should aim to maintain control of all reversible factors, as well as checking the status of organ damage.2
    • Serum potassium and creatinine should be monitored at least annually.3
    • Changes in left ventricular mass and carotid artery wall thickness are slow, and therefore these examinations should be performed annually.2
       
  • In correctly diagnosed patients in the general population, cessation of treatment is usually followed by recurrence of hypertension.2 Therefore treatment for hypertension should continue for life, unless the underlying cause (e.g. renal artery stenosis) can be fully reversed.2
     


Compared with monitoring BP solely in the clinic, monitoring BP at home may help patients to overcome therapeutic inertia and may also be associated with a small, but significant, reduction in hypertension.4



For further information on recommended follow-up assessments and approaches to maximize adherence, access the European Society of Cardiology and European Society of Hypertension Guidelines (2007), or access the US Department of Health and Human Services JNC7 express report (2003). 




References

  1. European AIDS Clinical Society (EACS). Guidelines. Version 6.0. Accessed 3 July 2012.
  2. The task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). 2007 Guidelines for the Management of Arterial Hypertension. Eur Heart J. 2007;28:1462–1536.
  3. US Department of Health and Human Services. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. December 2003. Accessed 8 March 2011.
  4. Agarwal R, Bills JE, Hecht TJ, et al. Role of home blood pressure monitoring in overcoming therapeutic inertia and improving hypertension control: a systematic review and meta-analysis. Hypertension. 2011;57:29–38.