2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8).

Por: Paul A. James, MD; Suzanne Oparil, MD; Barry L. Carter, PharmD; William C. Cushman, MD; Cheryl Dennison-Himmelfarb, RN, ANP, PhD; Joel Handler, MD; Daniel T. Lackland, DrPH; Michael L. LeFevre,MD, MSPH; Thomas D. MacKenzie,MD, MSPH; Olugbenga Ogedegbe,MD, MPH, MS; Sidney C. Smith Jr, MD; Laura P. Svetkey,MD, MHS; Sandra J. Taler, MD; Raymond R. Townsend, MD; Jackson T.Wright Jr,MD, PhD; Andrew S. Narva y MD; Eduardo Ortiz, MD, MPH.

JAMA. doi:10.1001/jama.2013.284427

Hypertension is the most common condition seen in primary care and leads to myocardial infarction, stroke, renal failure, and death if not detected early and treated appropriately.
Patients want to be assured that blood pressure (BP) treatment will reduce their disease burden, while clinicians want guidance on hypertension management using the best scientific evidence.
This report takes a rigorous, evidence-based approach to recommend treatment thresholds, goals, and medications in the management of hypertension in adults. Evidence was drawn from randomized controlled trials, which represent the gold standard for determining efficacy and effectiveness. Evidence quality and recommendations were graded based on their effect on important outcomes.

Tags: JNC 8

Visit-to-visit systolic blood pressure variability and outcomes in hemodialysis

Por: T I Chang, J E Flythe, S M Brunelli, P Muntner, T Greene, A K Cheung y G M Chertow.  Journal of Human Hypertension (2014) 28, 18–24.

Visit-to-visit blood pressure variability (VTV-BPV) is an independent risk factor for cardiovascular events and death in the general population. We sought to determine the association of VTV-BPV with outcomes in patients on hemodialysis, using data from a National Institutes of Health-sponsored randomized trial (the HEMO study). We used the coefficient of variation (CV) and the average real variability in systolic blood pressure (SBP) as metrics of VTV-BPV. In all, 1844 out of 1846 randomized subjects had at least three visits with SBP measurements and were included in the analysis. Median follow-up was 2.5 years (interquartile range 1.3 –4.3 years), during which time there were 869 deaths from any cause and 408 (adjudicated) cardiovascular deaths.

Efficacy of newer versus older antihypertensive drugs in black patients living in sub-Saharan Africa

Por:  J R M’Buyamba-Kabangu, B C Anisiuba, M B Ndiaye, D Lemogoum, L Jacobs, C K Ijoma3, L Thijs, H J Boombhi, J Kaptue, P M Kolo, J B Mipinda, C E Osakwe, A Odili, B Ezeala-Adikaibe, S Kingue, B A Omotoso, S A Ba, I I Ulasi y J A Staessen.  Journal of Human Hypertension (2013) 27, 729–735, June 2013.

Sub-Saharan Africa is facing an epidemic of cardiovascular disease, mainly driven by hypertension. Depending on the age range in published studies, hypertension currently affects from 30% up to 60% of blacks, born and living in Africa. The 2003 guidelines of the World Health Organization and International Society of Hypertension (WHO/ISH) propose that for the majority of hypertensive patients without a compelling indication for another class of drugs, a low-dose diuretic should be considered as the first choice of therapy on the basis of comparative trial data, availability and cost.7 However, recent trials8, 9 proved benefit of newer vs older antihypertensive drugs in terms of blood pressure control, reduction of cardiovascular morbidity and mortality, and metabolic side effects.

Hypertension in Children and Adolescents—More Questions Than Answers

Por: Sarah D. de Ferranti, MD, MPH y Matthew W. Gillman, MD.  Arch Pediatr Adolesc Med. 2012;166(9):872-874.

In 2011, the National Heart, Lung, and Blood Institute Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents reiterated the recommendations in the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents published in 2004. These guidelines recommend universal blood pressure screening in pediatric practice starting at age 3 years. If an initial blood pressure (BP) reading exceeds the 90th percentile for age, sex, and height, the practitioner is to repeat the measurement, preferably at least twice on separate occasions. Then he or she can categorize the patient into prehypertensive (90th to 95th percentile), stage 1 hypertension (95th percentile to 5 mm Hg above the 99thpercentile), or stage 2 hypertension (above that high cutpoint).