Hypertension: Classification and treatment

Article written by BSCK II Nguyen Quoc Viet, Department of Medical Examination & Internal Medicine, Vinmec Danang International General Hospital

High blood pressure is a very dangerous disease, affecting cardiovascular health even death if not controlled and treated well. The best way to treat it is to use medicine as prescribed by your doctor. Depending on the condition of the disease, the doctor will prescribe different drugs and doses.

Blood pressure is associated with cardiovascular, renal and mortality events, occurring continuously. Hypertension is defined as therapeutic blood pressure levels that clearly show benefit relative to the risk of harm through the results of clinical trials.
Although there is a lot of new evidence, further research and evaluation is needed for a change in definition and classification. The Vietnam Heart Association and the Vietnam Association of Hypertension (2018) still use the definition and classification of hypertension according to 2015 recommendations. Diagnosis of hypertension when measuring blood pressure in the clinic has a SBP ≥ 140 mmHg and/ or SBP ≥90 mmHg.
Table 1: Definition and classification of hypertension according to blood pressure levels measured in the clinic, continuously and at home (mmHg)

The 2018 European Hypertension Guidelines have lowered the overall target blood pressure to 130/80 mmHg as in the ACC/AHA 2017 guidelines. In addition, the ESC/ESH has also provided a target range of blood pressure. pressure instead of just the upper limit as earlier guidelines for both SBP and DBP to avoid excessive hypotension.
Target SBP is ≤130 mmHg if tolerated, but ≥120 mmHg and 130-139 mmHg for patients ≥65 years of age, target DBP is 70-79 mmHg for all patients.

Drug treatment of hypertension is the most effective strategy to reduce blood pressure and associated cardiovascular risk. However, the proportion of patients with blood pressure control remains low (often <50% of treated patients), a situation that becomes more difficult as new guidelines tend to lower the target. blood pressure.
The “traditional” tiered approach often results in too many patients being prescribed monotherapy – often ineffective, poor blood pressure control. Most patients need to be treated with a combination of drugs. However, the disadvantage of this method is that the use of many different pills leads to poor adherence.

The solution to this problem is to use multi-active tablets. Advantages:
Quick onset, well tolerated and more effective blood pressure control. Patients have better adherence to treatment. The approach to drug treatment is practical and simple, reducing the burden of costs.

The main classes of antihypertensive drugs 1/ Angiotensin-converting enzyme inhibitors (ACEI commonly used as captopril, enalapril, lisinopril, quinapril, perindopril..),
2/ Angiotensin receptor blockers (ARBs commonly used as candesartan). , telmisartan, losartan, irbesartan, valsartan,..),
3/ Calcium channel blockers (CCBs such as lercardipine, amlodipine, nifedipine, felodipine..)
4/ Diuretics (thiazides and thiazide-like diuretics such as chlorthalidone and indapamide)
5/ beta-blockers (BB- such as propranolol, atenolol, metoprolol, carvedilol, nebivolol..)
Antihypertensive drug classes have been shown to be effective in lowering blood pressure and cardiovascular events in research RCT and is the main indication in treatment.

Most patients are recommended a drug combination at the start of treatment, where preferred combinations include: ACEI or ARB plus CCB such as coveram (amlodipine + perindopril), twynsta, exforge (amlodipine + valsartan) ) or with diuretics such as atasart-H (candesartan + hypochlorothiazide), zestoretic (lisinopril + hypochlorothiazide). In addition, it is also possible to combine other 5 main drug groups. IA Beta-blockers are recommended in combination with drugs in the 5 main drug classes if the patient has a suitable medical condition such as angina, post-myocardial infarction, heart failure, or heart rate control. IA Initiate treatment of hypertension with a 2-drug combination, preferably in a 1-tablet combination, except in elderly, frail patients and patients with low-risk grade 1 hypertension (SBP << 150 mmHg). IB If the patient's blood pressure cannot be controlled with a 2-drug combination, a 3-drug combination treatment is recommended: ACEI/ARB + ​​CCB + thiazide diuretic/thiazide-like diuretic, preferably in 1 tablet combination. such as ACEIs, CCBs and diuretics such as triplexam (perindopril + amlodipine + indapamide) or exforge HCT (valsartan + amlodipine + hypochlorothiazide). IA If the patient's blood pressure is not controlled with the triple combination, add spironolactone or other diuretics if spironolactone (amiloride or other higher dose diuretics) or beta-blocker or alpha-blocker is not tolerated. IB The combination of two drugs that inhibit the renin-angiotensin system is not recommended. IIIA .

Diagnosis and classification of hypertension when the clinic blood pressure is ≥140/90 mmHg unchanged from the 2015 recommendation. Determining the goal of hypertension treatment is to reduce cardiovascular morbidity and mortality and overall mortality. . The overall BP goal should be <140/90 mmHg but well-tolerated should be <130/80 mmHg, considering the target boundary to ensure low blood pressure at a safe level. Identify 5 main drug groups LT, ACEi, ARB, CKCa, CB all effective. A fixed-dose single-pill treatment strategy with a two- or three-drug combination to improve BP control, improve adherence, and prioritize initial therapy with a fixed-dose combination of two drugs in the majority of patients. hypertension. Simplified regimens with a preference for ACEIs/ARBs + CKCa and/or fixed-dose thiazide/thiazides-like diuretics as the core treatment strategy for most patients, CB for when there are specific indications brand. Detect poor adherence, notice barriers, and strategies to improve blood pressure monitoring control. Recommendations are only a guide. In the management of hypertensive patients, clinical judgment remains and individualized response to therapy is key.

To control blood pressure and blood pressure-related diseases effectively, you should check your general health regularly. Currently, Vinmec International General Hospital has general health checkup packages suitable for each age, gender and individual needs of customers with a reasonable price policy, including:
Health checkup package general Vip Standard general health checkup package Patient's examination results will be returned to your home. After receiving the results of the general health examination, if you detect diseases that require intensive examination and treatment, you can use services from other specialties right at the Hospital with quality treatment and services. outstanding customer service.