"The Seventh Report of the Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure" provides a new guideline
for hypertension prevention and management. The following are the key messages(1) In persons older than 50 years, systolic blood pressure (BP) of
more than 140 mm Hg is a much more important cardiovascular disease
(CVD) risk factor than diastolic BP; (2) The risk of CVD, beginning at 115/75
mm Hg, doubles with each increment of 20/10 mm Hg; individuals who are normotensive
at 55 years of age have a 90% lifetime risk for developing hypertension; (3)
Individuals with a systolic BP of 120 to 139 mm Hg or a diastolic BP of 80
to 89 mm Hg should be considered as prehypertensive and require health-promoting
lifestyle modifications to prevent CVD; (4) Thiazide-type diuretics should
be used in drug treatment for most patients with uncomplicated hypertension,
either alone or combined with drugs from other classes. Certain high-risk
conditions are compelling indications for the initial use of other antihypertensive
drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor
blockers, β-blockers, calcium channel blockers); (5) Most patients with
hypertension will require 2 or more antihypertensive medications to achieve
goal BP (<140/90 mm Hg, or <130/80 mm Hg for patients with diabetes
or chronic kidney disease); (6) If BP is more than 20/10 mm Hg above goal
BP, consideration should be given to initiating therapy with 2 agents, 1 of
which usually should be a thiazide-type diuretic; and (7) The most effective
therapy prescribed by the most careful clinician will control hypertension
only if patients are motivated. Motivation improves when patients have positive
experiences with and trust in the clinician. Empathy builds trust and is a
potent motivator. Finally, in presenting these guidelines, the committee recognizes
that the responsible physician's judgment remains paramount.

https://jamanetwork.com/journals/jama/articlepdf/196589/JSC30096.pdf

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.

The National High Blood Pressure Education Program presents the complete Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Like its predecessors, the purpose is to provide an evidence-based approach to the prevention and management of hypertension. The key messages of this report are these: in those older than age 50, systolic blood pressure (BP) of greater than 140 mm Hg is a more important cardiovascular disease (CVD) risk factor than diastolic BP; beginning at 115/75 mm Hg, CVD risk doubles for each increment of 20/10 mm Hg; those who are normotensive at 55 years of age will have a 90% lifetime risk of developing hypertension; prehypertensive individuals (systolic BP 120-139 mm Hg or diastolic BP 80-89 mm Hg) require health-promoting lifestyle modifications to prevent the progressive rise in blood pressure and CVD; for uncomplicated hypertension, thiazide diuretic should be used in drug treatment for most, either alone or combined with drugs from other classes; this report delineates specific high-risk conditions that are compelling indications for the use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); two or more antihypertensive medications will be required to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg) for patients with diabetes and chronic kidney disease; for patients whose BP is more than 20 mm Hg above the systolic BP goal or more than 10 mm Hg above the diastolic BP goal, initiation of therapy using two agents, one of which usually will be a thiazide diuretic, should be considered; regardless of therapy or care, hypertension will be controlled only if patients are motivated to stay on their treatment plan. Positive experiences, trust in the clinician, and empathy improve patient motivation and satisfaction. This report serves as a guide, and the committee continues to recognize that the responsible physician's judgment remains paramount.

Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

ABCD
: Appropriate Blood pressure Control in Diabetes
ABI
: ankle–brachial index
ABPM
: ambulatory blood pressure monitoring
ACCESS
: Acute Candesartan Cilexetil Therapy in Stroke Survival
ACCOMPLISH
: Avoiding Cardiovascular Events in Combination Therapy in Patients Living with Systolic Hypertension
ACCORD
: Action to Control Cardiovascular Risk in Diabetes
ACE
: angiotensin-converting enzyme
ACTIVE I
: Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events
ADVANCE
: Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation
AHEAD
: Action for HEAlth in Diabetes
ALLHAT
: Antihypertensive and Lipid-Lowering Treatment to Prevent Heart ATtack
ALTITUDE
: ALiskiren Trial In Type 2 Diabetes Using Cardio-renal Endpoints
ANTIPAF
: ANgioTensin II Antagonist In Paroxysmal Atrial Fibrillation
APOLLO
: A Randomized Controlled Trial of Aliskiren in the Prevention of Major Cardiovascular Events in Elderly People
ARB
: angiotensin receptor blocker
ARIC
: Atherosclerosis Risk In Communities
ARR
: aldosterone renin ratio
ASCOT
: Anglo-Scandinavian Cardiac Outcomes Trial
ASCOT-LLA
: Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm
ASTRAL
: Angioplasty and STenting for Renal Artery Lesions
A-V
: atrioventricular
BB
: beta-blocker
BMI
: body mass index
BP
: blood pressure
BSA
: body surface area
CA
: calcium antagonist
CABG
: coronary artery bypass graft
CAPPP
: CAPtopril Prevention Project
CAPRAF
: CAndesartan in the Prevention of Relapsing Atrial Fibrillation
CHD
: coronary heart disease
CHHIPS
: Controlling Hypertension and Hypertension Immediately Post-Stroke
CKD
: chronic kidney disease
CKD-EPI
: Chronic Kidney Disease—EPIdemiology collaboration
CONVINCE
: Controlled ONset Verapamil INvestigation of CV Endpoints
CT
: computed tomography
CV
: cardiovascular
CVD
: cardiovascular disease
D
: diuretic
DASH
: Dietary Approaches to Stop Hypertension
DBP
: diastolic blood pressure
DCCT
: Diabetes Control and Complications Study
DIRECT
: DIabetic REtinopathy Candesartan Trials
DM
: diabetes mellitus
DPP-4
: dipeptidyl peptidase 4
EAS
: European Atherosclerosis Society
EASD
: European Association for the Study of Diabetes
ECG
: electrocardiogram
EF
: ejection fraction
eGFR
: estimated glomerular filtration rate
ELSA
: European Lacidipine Study on Atherosclerosis
ESC
: European Society of Cardiology
ESH
: European Society of Hypertension
ESRD
: end-stage renal disease
EXPLOR
: Amlodipine–Valsartan Combination Decreases Central Systolic Blood Pressure more Effectively than the Amlodipine–Atenolol Combination
FDA
: U.S. Food and Drug Administration
FEVER
: Felodipine EVent Reduction study
GISSI-AF
: Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-Atrial Fibrillation
HbA1c
: glycated haemoglobin
HBPM
: home blood pressure monitoring
HOPE
: Heart Outcomes Prevention Evaluation
HOT
: Hypertension Optimal Treatment
HRT
: hormone replacement therapy
HT
: hypertension
HYVET
: HYpertension in the Very Elderly Trial
IMT
: intima-media thickness
I-PRESERVE
: Irbesartan in Heart Failure with Preserved Systolic Function
INTERHEART
: Effect of Potentially Modifiable Risk Factors associated with Myocardial Infarction in 52 Countries
INVEST
: INternational VErapamil SR/T Trandolapril
ISH
: Isolated systolic hypertension
JNC
: Joint National Committee
JUPITER
: Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin
LAVi
: left atrial volume index
LIFE
: Losartan Intervention For Endpoint Reduction in Hypertensives
LV
: left ventricle/left ventricular
LVH
: left ventricular hypertrophy
LVM
: left ventricular mass
MDRD
: Modification of Diet in Renal Disease
MRFIT
: Multiple Risk Factor Intervention Trial
MRI
: magnetic resonance imaging
NORDIL
: The Nordic Diltiazem Intervention study
OC
: oral contraceptive
OD
: organ damage
ONTARGET
: ONgoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial
PAD
: peripheral artery disease
PATHS
: Prevention And Treatment of Hypertension Study
PCI
: percutaneous coronary intervention
PPAR
: peroxisome proliferator-activated receptor
PREVEND
: Prevention of REnal and Vascular ENdstage Disease
PROFESS
: Prevention Regimen for Effectively Avoiding Secondary Strokes
PROGRESS
: Perindopril Protection Against Recurrent Stroke Study
PWV
: pulse wave velocity
QALY
: Quality adjusted life years
RAA
: renin-angiotensin-aldosterone
RAS
: renin-angiotensin system
RCT
: randomized controlled trials
RF
: risk factor
ROADMAP
: Randomized Olmesartan And Diabetes MicroAlbuminuria Prevention
SBP
: systolic blood pressure
SCAST
: Angiotensin-Receptor Blocker Candesartan for Treatment of Acute STroke
SCOPE
: Study on COgnition and Prognosis in the Elderly
SCORE
: Systematic COronary Risk Evaluation
SHEP
: Systolic Hypertension in the Elderly Program
STOP
: Swedish Trials in Old Patients with Hypertension
STOP-2
: The second Swedish Trial in Old Patients with Hypertension
SYSTCHINA
: SYSTolic Hypertension in the Elderly: Chinese trial
SYSTEUR
: SYSTolic Hypertension in Europe
TIA
: transient ischaemic attack
TOHP
: Trials Of Hypertension Prevention
TRANSCEND
: Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease
UKPDS
: United Kingdom Prospective Diabetes Study
VADT
: Veterans' Affairs Diabetes Trial
VALUE
: Valsartan Antihypertensive Long-term Use Evaluation
WHO
: World Health Organization

### 1.1 Principles

The 2013 guidelines on hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology …

/pdf/2013-esh-esc-guidelines-for-the-management-of-arterial-4ydvs5ifsx.pdf

2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).

2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.

THE DESIGN AND ANALYSIS OF EXPERIMENTS. By Oscar Kempthorne. New York, John Wiley and Sons, Inc., 1952. 631 pp. $8.50. This book by a teacher of statistics (as well as a consultant for \"experimenters\") is a comprehensive study of the philosophical background for the statistical design of experiment. It is necessary to have some facility with algebraic notation and manipulation to be able to use the volume intelligently. The problems are presented from the theoretical point of view, without such practical examples as would be helpful for those not acquainted with mathematics. The mathematical justification for the techniques is given. As a somewhat advanced treatment of the design and analysis of experiments, this volume will be interesting and helpful for many who approach statistics theoretically as well as practically. With emphasis on the \"why,\" and with description given broadly, the author relates the subject matter to the general theory of statistics and to the general problem of experimental inference. MARGARET J. ROBERTSON

The Design and Analysis of Experiments

H ypertension is considered to be the most important reversible risk factor for disease and death by the WHO as recently pointed out in the publication of the 2015 Global Burden of Disease Study [1]. The prevalence and severity of hypertension vary between different continents and countries. The prevalence of hypertension in the African-American population is about 40% [2], and largely uncontrolled, whereas other ethnic groups including whites have better blood pressure (BP) control and lesssevere hypertension [2]. The reasons for this disparity between ethnic groups are partly unknown, but genetic and environmental factors may partly explain the high BP levels among the African-American people. Differences in awareness of high BP, screening and follow-up of AfricanAmericans may also contribute to the high prevalence of uncontrolled hypertension. Drugs to control hypertension are available, and hypertension can be controlled in the majority of patients. Actually, only about 5% of patients referred for apparent treatment-resistant hypertension truly have drug-resistant hypertension, that is refractory hypertension [3]. Both physicians’ inertia to treat hypertension and patients’ nonadherence to treatment are two major concerns and may be apparent even under strictly controlled conditions such as in clinical outcome trials [4]. Even patients with apparent resistant hypertension fail to comply despite volunteering for studies in which direct observational drug intake or measurements of blood concentrations of drugs are undertaken [5]. The adherence problem is likely complex, and multiple approaches may be needed to overcome the challenges [6]. In this issue of Journal of Hypertension, Ruppar et al. [7] did a systematic review and meta-analysis, assessing interventions with regard to adherence of BP medication in hypertensive African-American people. They identified 37

Interventions to improve adherence of antihypertensive medication in African-americans.

Exercise Blood Pressure: The Prognostic Impact of Exercise Systolic Blood Pressure

Elderly is a rapidly growing segment of the hypertensive population in major parts of the world. Older patients have the highest prevalence of hypertension and account for a large proportion of the total patient population in need of antihypertensive treatment. Among the potentially modifiable cardiovascular risk factors in the elderly, systolic hypertension is of major importance (1). The prevalence of isolated systolic hypertension increases gradually with age and averages about 25% of the population aged 80 years or more (2). Evidence accumulated in the past decade from large outcome trials have indicated that treatment benefits appears to be broadly consistent among a range of patient subpopulations and among antihypertensive agents (3). However, evidence showing that treating patients 80 years of age or older was beneficial long remained inconclusive. The past decade witnessed the publication of some outcome trials which aimed to address the question whether the cardiovascular risk conferred by hypertension could be reversed by antihypertensive drug treatment in the elderly (4,5,6,7). In this issue of Blood Pressure, Rosenthal and Nussinovitch (8) review the current practice of management of hypertension in the elderly. Elevated blood pressure is common in persons 80 years of age or older (9), a group which is the fastestgrowing segment of the general population in many countries. Rosenthal and Nussinovitch outline some important points to be considered in the management of elderly patients, such as the fact that pharmacokinetics and pharmacodynamics of antihypertensive drugs are often altered during aging, but also more importantly the potential problem of compliance that may be disrupted by depression, loss of memory, vascular dementia, and other conditions that compromise cognition. With the use of modern well documented antihypertensive drugs it is possible to tailor a drug regimen that is both effective and tolerable to most elderly patients (3).With that insight, management of hypertension in older people in primary care has improved in terms of detection and treatment, but in only one-third of patients is high blood pressure controlled. In the elderly, there are thus important opportunities for improved prevention of stroke and myocardial infarction through achievement of an improved blood pressure control. In this respect, the recent HYVET study (10) is interesting. The study found that, after a mean of 2.1 years of antihypertensive treatment with indapamide SR 1.5mg with/without perindopril 2–4mg daily, there was a significant reduction of mean sitting blood pressure by 15.0/6.1 mmHg versus placebo. The intention-to-treat analysis showed that active treatment was associated with a 30% reduction in the primary endpoint (p50.06), a 39% reduction in the rate of death from stroke (p50.046), a 21% reduction in all-cause death (p50.02), a 23% reduction in cardiovascular death (p50.06), and a 64% reduction in the rate of heart failure (pv0.001). These benefits from treatment were largely appearing within the first year, and adjustment for variables such as age, gender, previous cardiovascular disease, and baseline seated systolic BP did not to any extent change primary endpoint results nor the composite endpoint results. There were fewer serious adverse events reported in the active treatment group as compared to placebo therapy (358 vs. 448, respectively; p50.001). Only a few of these events (three in the placebo group and two in the active treatment group) were classified by the investigators as possibly related to the trial medication. Further analysis of the HYVET results support a target blood pressure of 150/80 mm Hg in patients receiving treatment, a target that was reached in approximately 50% of patients after 2 years. Blood Pressure. 2008; 17: 184–185

Management of older hypertensive patients

[Blood Pressure Treatment--towards consensus on many things].

Objective:To compare the efficacy and safety of telmisartan 40 mg (T40) or 80 mg (T80) plus hydrochlorothiazide 125 mg (H125) single-pill combinations (SPCs) with telmisartan monotherapies, in a pooled analysis of patients with mild to moderate hypertensionMethods:Six phase 3, double-blind studies of 8 weeks’ duration that assessed the T/H125 SPC and T40 or T80 monotherapy, were included in the analysis Data was pooled separately for the two T40 non-responder studies (T40 NR group, two T80 non-responder studies (T80 NR group), and the two factorial design dose–response studies (FD-DR group)Results:After 8 weeks’ treatment, the adjusted mean reduction in systolic blood pressure (SBP) and diastolic blood pressure (DBP), and the SBP, DBP, and blood pressure (BP) goal rates were significantly higher with the T40/H125 SPC than T40 in the T40 NR group and with the T80/H125 SPC than T80 in the T80 NR group In the FD-DR group, the adjusted mean reduction in SBP and DBP, and DBP goal rates were si

Sverre E. Kjeldsen

Papers

Interventions to improve adherence of antihypertensive medication in African-americans.

Exercise Blood Pressure: The Prognostic Impact of Exercise Systolic Blood Pressure

Management of older hypertensive patients

[Blood Pressure Treatment--towards consensus on many things].

Telmisartan in combination with hydrochlorothiazide 12.5 mg for the management of patients with hypertension