Accelerated Patient Care Strategies
- In France, nearly one in three adults has hypertension and only one in four hypertensive individuals is controlled.
- In addition to hypertension classically defined by blood pressure values ≥ 140/90 mm Hg, international experts also emphasize elevated blood pressure, i.e., between 120/70 mm Hg and 139/89...
- Unless in specific cases, the current blood pressure target is to aim, ideally, for 120/70 mm Hg, to ultimately reduce the risk of cardiovascular, renal, and ocular complications...
Summary
In France, nearly one in three adults has hypertension and only one in four hypertensive individuals is controlled. furthermore, a meaningful number of patients are unaware of their blood pressure levels and do not know they have hypertension, highlighting the importance of opportunistic screening at all ages.
In addition to hypertension classically defined by blood pressure values ≥ 140/90 mm Hg, international experts also emphasize elevated blood pressure, i.e., between 120/70 mm Hg and 139/89 mm Hg (120/70 ≤ PA ≤ 139/89), which may require, depending on the level of cardiovascular risk, the implementation of antihypertensive treatment.
Unless in specific cases, the current blood pressure target is to aim, ideally, for 120/70 mm Hg, to ultimately reduce the risk of cardiovascular, renal, and ocular complications related to hypertension.
To achieve this, lifestyle and dietary measures must be combined with dual antihypertensive therapy as soon as the diagnosis of hypertension is confirmed. Then, if this is not sufficient to normalize blood pressure values, a triple therapy should be used, after evaluating adherence to these measures and treatment compliance.
In the most fragile individuals, especially those over 85 years of age, the blood pressure target should be personalized, and, depending on the profile, it might potentially be 140/90 mm Hg.But, often, the choice of the target should be “as low as reasonably possible.”
In case of elevated blood pressure,and high cardiovascular risk,monotherapy with antihypertensive drugs is initiated if lifestyle and dietary measures are insufficient after 1 to 3 months.
The VIDALReco on the management of hypertension.
In cases of confirmed hypertension or confirmed elevated blood pressure through ambulatory measurements, a systematic blood test is recommended: CBC, electrolytes, calcium, uric acid, creatinine and glomerular filtration rate (GFR), TSH, blood glucose ± HbA1c, lipid profile assessment.
The systematic standardized measurement of aldosterone and renin is not universally agreed upon: it is recommended by the European Society of Cardiology (ESC) only in cases of confirmed hypertension, but not by the European Society of Hypertension (ESH).
The urine test includes the albumin/creatinine ratio and the search for hematuria.
An ECG is systematically performed.
Depending on the context, other complementary tests are requested.These are explained in the chapters “Secondary Hypertension” and “Assessment of overall cardiovascular risk” of the VIDAL Reco.
Managing High Blood Pressure in Older Adults
For older adults with confirmed hypertension (blood pressure ≥ 140/90 mmHg), initial treatment with a combination of two blood pressure medications, alongside non-pharmacological interventions, is recommended unless specific risk factors are present. These risk factors include orthostatic hypotension, age over 85 years, a life expectancy under 3 years, or moderate to severe frailty.
When possible, a fixed-dose combination containing a renin-angiotensin system (RAS) inhibitor - either an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB) – is preferred. the target blood pressure range is 120/70 mmHg to 129/79 mmHg. For patients with the aforementioned risk factors, a blood pressure of ≤ 140/90 mmHg is acceptable.
Patients should be reassessed after 1 to 3 months, with a rapid increase in medication dosages considered. If blood pressure goals aren’t met with a maximum tolerated dose of two medications, a three-drug combination should be discussed to prevent therapeutic inertia.