E-drug: New Consensus Statement on hypertension treatment
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[Here is important information for hypertension treatment watchers
among us. The consensus statement has been prepared by the
Hypertension in African Americans Working Group - the HAAW Group
(interesting acronym!). It contains specific guidelines for blood
pressure targets and drug therapy. However, an editorial in the very
journal laments the limited evidence base of the recommendations.
Remember the storm of criticism WHO got when it issued its
hypertension recommendations some time ago, and industry influence
was suspected. Nevertheless, the editorial also states that "even
though the evidence base is not very strong, the HAAW Group's
recommendation to use initial combination therapy to lower
baseline-to-target blood pressure more than 15 mm Hg systolic or 10
mm Hg diastolic is clinically rational". Comments from E-druggers
welcome. Thanks to Kirsten Myhr for spotting this. The report can
be viewed for free at http://archinte.ama-assn.org/ HH]
Management of High Blood Pressure in African Americans
Consensus Statement of the Hypertension in African Americans
Working Group of the International Society on Hypertension in Blacks
J.G. Douglas, et.al. The Hypertension in African Americans Working
Group
Arch Intern Med. 2003;163:525-541.
http://archinte.ama-assn.org/
The need for specific recommendations for managing high blood
pressure in African Americans is highlighted by compelling evidence of
poorer cardiovascular and renal outcomes in this group compared with
white Americans. Barriers to normalizing blood pressure in African
Americans are too often attributed to biological and social factors, with
an inadequate focus on the role of medical management. Simply
stated, a key obstacle is the failure of medical providers to treat high
blood pressure early and persistently to an appropriate blood pressure
target. A new approach is needed to reduce the adverse outcomes
associated with high blood pressure in African Americans. Traditional
strategies (eg, accepting blood pressure levels above target goals,
titrating to high-dose monotherapy, and avoiding specific classes of
antihypertensive medications) have proved unsuccessful. The "best
practice" strategies described in this article are intended to achieve
efficacy in blood pressure reduction in tandem with protection against
target-organ damage. These strategies involve assessing
cardiovascular risk; setting, achieving, and maintaining an appropriate
blood pressure target; assisting patients to implement therapeutic
lifestyle changes; and initiating effective pharmacologic interventions
early and persistently.
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