Practical new ASH/ISH guideline on diagnosis and treatment of hypertension

The American Society of Hypertension (ASH) and the International Society of Hypertension (ISH) have published a new guideline on diagnosis and treatment of hypertension around the world, regardless of available technology.

“Our goal has been to give sufficient information to enable health care practitioners, wherever they are located, to provide professional care for people with hypertension,” the authors wrote. “We hope that we have allowed sufficient flexibility in this statement to enable responsible clinicians to device workable plans for providing the best possible care for patients with hypertension in their communities.”

The ASH/ISH guideline defines hypertension as systolic blood pressure (BP) ≥140 mm Hg or diastolic BP ≥90 mm Hg, or both upon repeated examination. For people aged at least 80 years, a definition of systolic BP ≥150 mm Hg is acceptable. The authors note that there is insufficient evidence of benefits of treating patients under 55 years to BP targets lower than systolic BP < 140 mmHg and diastolic BP < 90 mmHg. No specific targets are recommended for black patients, but it is pointed out that they often have earlier and more severe hypertension than other groups.

Methods of BP measurement to diagnose hypertension are discussed, including in the case of suspected white-coat hypertension. Attention is also given to the need for a physical exam including history taking on other CV risk factors. Life style changes should be given priority. In the case of hypertension not worse than stage I life style changes alone may be attempted for 6-12 months, before starting medication.

Specific treatment recommendations are given for different patients groups and different stages of hypertension. It is acknowledged that most patients will require more than one drug to achieve BP control, and guidance is given on how to increase the treatment regimen.

Recommendations are done on how to deal with suspected treatment-resistant hypertension, not only to measure BP at home or via 24-hour ambulatory BP monitoring, but also to check medication use, and which conditions to rule out that might cause secondary hypertension.

This guideline is issued briefly after the new JNC 8 hypertension guideline. While the JNC 8 guideline focuses on evidence-based recommendations, the ASH/ISH document is a more practical approach based on expert opinion. The recommendations in the two guidelines overlap substantially.

Find the ASH/ISH guideline online