Blood pressure guidelines

I nearly forgot to mention the most important weapons to lower blood pressure and prevent cardiovascular disease, heart attack, and stroke. You ve read about ways to cope with stress, lose weight, quit smoking cigarettes, become more physically active, improve your diet, and counterbalance salt and sodium. You ve learned about natural, safe, and clinically documented effective supplements that can dramatically lower both systolic and diastolic blood pressure. Those supplements weren t even available when I was first inspired to write this book after studying newly published blood pressure guidelines in 2003. So what s missing ... 

Recent consensus committees, including the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) and the World Health Organization-International Society of Hypertension (WHO-ISH) Guidelines Subcommittee, have modified traditional treatment recommendations in several important ways. 

The primary healtii care provider is kept informed of die patient s response to die drug because a dosage change may be necessary. The primary healdi care provider establishes guidelines for die regulation of die IV infusion rate, as well as die blood pressure and pulse ranges tiiat require stopping die IV infusion. 

The selection of blood pressure cuff size based on a patient s arm circumference is crucial for the accurate measurement of blood pressure. Systolic and diastolic blood pressure tend to increase when the cuff size is too small relative to the patient s arm circumference. This circumstance is important due to the increasing prevalence of obesity in developed nations. Currently, the guidelines of the American College of Cardiology/American Heart Association (ACC/AHA) Blood Pressure Measurement in Humans recommends cuff sizes for small, standard, and large adults with an optimal 2 1 ratio of cuff length/width based on arm circumference.18... 

Lowering blood pressure in patients who are hypertensive has been shown to reduce the relative risk of stroke, both ischemic and hemorrhagic, by 35% to 45%.23 Also, the more blood pressure is lowered, the greater the reduction in stroke risk.24 All patients should have their blood pressure monitored and controlled appropriately based on current guidelines for blood pressure management. However, no one agent has been clearly shown to be more beneficial than any other for preventing stroke. 

Elevated blood pressure is common after ischemic stroke, and its treatment is associated with a decreased risk of stroke recurrence. The Joint National Committee and AHA/ASA guidelines recommend an angiotensin-converting enzyme inhibitor and a diuretic for reduction of blood pressure in patients with stroke or TIA after the acute period (first 7 days). Angiotensin II receptor blockers have also been shown to reduce the risk of stroke and should be considered in patients unable to tolerate angiotensinconverting enzyme inhibitors after acute ischemic stroke. 

There are currently no standard pharmacologic strategies for treating intracerebral hemorrhage. Medical guidelines for managing blood pressure, increased intracranial pressure, and other medical complications in acutely ill patients in neurointensive care units should be followed. 

In early stage CKD, the target blood pressure for cardiovascular risk reduction is 130/80 mm Hg. The K/DOQI guidelines propose a predialysis blood pressure of less than 140/90 mm Hg and a postdialysis blood pressure of less than 130/80 mm Hg. 

A 5 year randomized clinical trial in the United States found that in spite of the availability of hypertensive medication, awareness promotions, and guidelines, only a third of all the hypertensive patients have their blood pressure under effective control due to noncompUance in medication. More tailored behavioral management intervention may help to improve compliance and achieve better control. 

The ICH guideline lists the assessment of effects on blood pressure, heart rate and ECG. In vivo, in vitro and/or ex vivo evaluations, including methods for electrical repolarisation and conductance abnormalities, should also be considered. These abnormalities can be associated with risks for fatal ventricular arrhythmias called Torsade de pointes. 

NHLBl, The seventh report of the joint national committee on the prevention, detection, evaluation and treatment of High Blood Pressure (JNC VII). Available at http //www.nhlbi.nih.gov/ guidelines/hypertension/ last accessed March 4, 2007. 

Table 8. General guidelines to improve patient adherence to antihypertensive therapy (Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure, 1997)...

The American Heart Association (AHA) Guidelines 2005 state that Accurate measurement of blood pressure is essential to classify individuals, to ascertain blood pressure related-risk and to guide management. The auscultatory technique with a trained observer and mercury manometer continues to be the method of choice in the office. The oscillometric method can be used for office measurement, but only devices independently validated according to standard protocols should be used, and individual calibration is recommended (3). 

Individual lifestyle modifications that are known to reduce blood pressure include (North of England Hypertension Guideline Development Group, 2006) ... 

It should be remembered that hypertension in patients with renal dysfunction can be particularly difficult to treat, and many patients require more than one antihypertensive agent in order to control their blood pressure. There is some guidance provided by the Renal Association in their Clinical Guidelines document as to choice of therapeutic agent ... 

In addition to evidence of regional variahon, healfh services research had demonstrated decreased rates of adherence fo accepted evidence-based therapeutic guidelines. Despite widely known professional guidelines (i.e., sixfh report of the Joint National Committee, JNC-VI), medical consensus on the health benefits of blood pressure confrol, and availability of effective mediations, blood pressure is poorly controlled in the U.S. Data from a nahonal research study found fhaf only 68% of pafienfs with hypertension are aware of fheir condition, and of those treated, only 27% have their blood pressures controlled. 

But I continue to tweak my own regimen as I learn new approaches. And that s why the newest, seventh edition of guidelines issued by the Joint National Committee (JNC7) on blood pressure and hypertension in 2003 really caught my attention. For years. I d thought that my own blood pressure was perfectly fine, and so did the doctors who examined and tested me. The new guidelines, however, labeled me as prehypertensive. At first, I dismissed the stricter limits as being overly cautious. Actually, a lot of physicians reacted the same way. After all, my numbers, typically around 125/80, had been considered normal, and no doctor had ever talked about any need to lower it. 

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