Global Impact of 2017 American College of Cardiology/American Heart Association Hypertension Guidelines
2018; Lippincott Williams & Wilkins; Volume: 137; Issue: 6 Linguagem: Inglês
10.1161/circulationaha.117.032890
ISSN1524-4539
Autores Tópico(s)Cardiac, Anesthesia and Surgical Outcomes
ResumoHomeCirculationVol. 137, No. 6Global Impact of 2017 American College of Cardiology/American Heart Association Hypertension Guidelines Free AccessArticle CommentaryPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessArticle CommentaryPDF/EPUBGlobal Impact of 2017 American College of Cardiology/American Heart Association Hypertension GuidelinesA Perspective From China Ji-Guang Wang, MD, PhD and Lisheng Liu, MD Ji-Guang WangJi-Guang Wang Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, China (J.-G.W.) Search for more papers by this author and Lisheng LiuLisheng Liu Beijing Hypertension League Institute, China (L.L.) Search for more papers by this author Originally published6 Feb 2018https://doi.org/10.1161/CIRCULATIONAHA.117.032890Circulation. 2018;137:546–548A shocking change in the 2017 American College of Cardiology/American Heart Association hypertension guidelines is the shift in the definition of hypertension from 140/90 mm Hg to 130/80 mm Hg for systolic/diastolic blood pressure.1 It was indeed a major change since the definition of hypertension was changed from 160/90 mm Hg to 140/90 mm Hg in the fifth report of the Joint National Committee published in 1993.2 History is often repeated and similarities sometimes emerge. Very similar to the change in 1993,2 the current change in the 2017 guidelines was mainly based on epidemiological evidence but not randomized controlled clinical trials.1 There is strong and consistent evidence that lower blood pressure is associated with lower cardiovascular risk, even if not to the point of the lower the better. There is little or insufficient evidence on the outcome benefit of antihypertensive therapy from adequately powered, placebo-controlled clinical trials even in the range of systolic blood pressure from 140 to 159 mm Hg, needless to say for 130 to 139 mm Hg. However, the current change,1 like the previous one,2 is probably not only conceptually encouraging, but also eventually beneficial for cardiovascular prevention. The concept of treating early is actually in line with the life course approach proposed in the call to action of the Lancet Hypertension Commission published in 2016.3To judge the usefulness and appropriateness of the new threshold, we have to look at its influence in both short- and long-term perspectives. The latter, of course, requires time and can only be judged historically according to the incidence of the cardiovascular complications of hypertension. However, a short-term judgment can be accomplished shortly according to whether the change would improve blood pressure control, without substantially increasing the cost, workload, and side effects of treatment. If we apply the 130/80 mm Hg threshold to the most recent China national survey data, the prevalence of hypertension would increase from ≈25% to 50%. However, because, in the 130 to 139/80 to 89 mm Hg range of systolic/diastolic blood pressure, only those with clinical cardiovascular disease, ie, coronary heart disease, congestive heart failure, and stroke, or with a 10-year atherosclerotic cardiovascular disease risk >10%, would require antihypertensive treatment,1 the increment in the number of patients requiring treatment would be marginal. Indeed, in our studies in a general population4 and an elderly population,5 the increase was 2.0% and 5.5%, respectively (Figure). If the <50% of the overall awareness rate of hypertension in China were taken into account, the increase in the number of treated hypertensive patients would be almost negligible.Download figureDownload PowerPointFigure. Prevalence of hypertension and the proportion of patients who would require antihypertensive treatment according to the 140/90 mm Hg and 130/80 mm Hg criteria, respectively, in a general population4 and an elderly population.5 The total number of study subjects is given at the bottom.In line with the change in the diagnostic threshold of hypertension, the therapeutic target was also changed from 140/90 mm Hg in general and 130/80 mm Hg in patients at high risk to 130/80 mm Hg in general.1 This change may have an impact on the intensity of antihypertensive treatment and ultimately blood pressure control and prevention of both acute cardiovascular events and chronic cardiovascular illnesses. Targeting 130/80 mm Hg will definitely increase the control rate as assessed according to the 140/90 mm Hg criteria. Increasing treatment intensity will theoretically increase the cost for medication and care from health professionals. However, treating early and intensively may retard the progression of hypertension, prevent resistant hypertension, and, in the long run, reduce cost. Thus, the totality is not only cost saving, but probably also lifesaving. In addition, with the increasing use of efficacious and safe generic medications, increasing sales volume does not necessarily mean an increase of cost.The new guideline is a comprehensive document.1 There are several gems hidden by the striking changes in the diagnostic threshold and therapeutic target of hypertension. First, ambulatory blood pressure was recommended for the first time in an American guideline document for the management of hypertension in adults. This is indeed an important step forward. Ambulatory blood pressure monitoring is useful in the identification of white coat and masked hypertension, and the only reliable method for the diagnosis of nocturnal hypertension, which confers cardiovascular risk independent of clinic and daytime ambulatory blood pressure. Second, this new guideline re-recommended cardiovascular risk stratification for the decision to use antihypertensive therapy that had been proposed in the sixth report of the Joint National Committee. This new risk assessment approach was not exactly the same as the one used in the fifth report of the Joint National Committee, and because of its quantitative nature may be clinically useful on the basis of the individual patient. Third, the new guidelines clearly recommended screening for secondary hypertension and provided information on who (or when), which, and how secondary hypertension should be screened. Systematic screening might lead to a much higher detection rate of all forms of secondary hypertension and to a paradigm shift from blood pressure control alone with or without risk management to the treatment of disease.After publication of the new guidelines,1 a question was repeatedly asked by colleagues in China and those from other countries, including the United States, whether the Chinese hypertension guidelines will follow the definition of hypertension. The short answer is no. The full answer is definitely not for the moment. The Chinese hypertension guidelines have to seriously consider the current situation in the management of hypertension in China. A major concern is the extremely low awareness of hypertension. However, with the establishment of nationwide community health services for noncommunicable chronic disease management and the increasing use of home blood pressure monitoring, the situation is improving rapidly.5 The awareness and control rates of hypertension have increased substantially in some of the better-developed areas in China. In an elderly population study in Shanghai, the awareness and control rates of hypertension in 2006 to 2007 reached 71.2% and 25.7%, respectively.5 We are fully confident that we will soon catch up. Then, probably in 5 to 10 years, we may have the imperative to change the definition of hypertension in the Chinese hypertension guidelines.DisclosuresNone.FootnotesThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.Circulation is available at http://circ.ahajournals.org.Correspondence to: Ji-Guang Wang, MD, PhD, The Shanghai Institute of Hypertension, Ruijin 2nd Rd 197, Shanghai 200025, China. E-mail [email protected]References1. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines (published online ahead of print November 13, 2017).Hypertension. doi: 10.1161/HYP.0000000000000065. https://www.ncbi.nlm.nih.gov/pubmed/29133356Google Scholar2. Gifford RW. The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC V).Arch Intern Med. 1993; 153:154–183.CrossrefMedlineGoogle Scholar3. Olsen MH, Angell SY, Asma S, Boutouyrie P, Burger D, Chirinos JA, Damasceno A, Delles C, Gimenez-Roqueplo AP, Hering D, López-Jaramillo P, Martinez F, Perkovic V, Rietzschel ER, Schillaci G, Schutte AE, Scuteri A, Sharman JE, Wachtell K, Wang JG. A call to action and a lifecourse strategy to address the global burden of raised blood pressure on current and future generations: the Lancet Commission on hypertension.Lancet. 2016; 388:2665–2712. doi: 10.1016/S0140-6736(16)31134-5.CrossrefMedlineGoogle Scholar4. Sheng CS, Liu M, Zou J, Huang QF, Li Y, Wang JG. Albuminuria in relation to the single and combined effects of systolic and diastolic blood pressure in Chinese.Blood Press. 2013; 22:158–164. doi: 10.3109/08037051.2012.748998.CrossrefMedlineGoogle Scholar5. Sheng CS, Liu M, Kang YY, Wei FF, Zhang L, Li GL, Dong Q, Huang QF, Li Y, Wang JG. Prevalence, awareness, treatment and control of hypertension in elderly Chinese.Hypertens Res. 2013; 36:824–828. doi: 10.1038/hr.2013.57.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Bolin L, Saul A, Bethune Scroggs L and Horne C (2022) A pilot study investigating the relationship between heart rate variability and blood pressure in young adults at risk for cardiovascular disease, Clinical Hypertension, 10.1186/s40885-021-00185-z, 28:1, Online publication date: 1-Dec-2022. He J, Li Z, Wang R, Nie H, Wang F, Yuan J, Miao X, Yao P, Wei S, Zhang X, Guo H, Yang H, Wu T and He M (2021) Association of blood pressure and long‐term change with chronic kidney disease risk among Chinese adults with different glucose metabolism according to the 2017 ACC/AHA guidelines, The Journal of Clinical Hypertension, 10.1111/jch.14371, 23:12, (2080-2088), Online publication date: 1-Dec-2021. Liu S, Yuan H, Jiang C, Xu J, Qiu X and Luo J (2021) The blood pressure control and arteriosclerotic cardiovascular risk among Chinese community hypertensive patients, Scientific Reports, 10.1038/s41598-021-98745-8, 11:1, Online publication date: 1-Dec-2021. Li F, He Y, Yang H, Liu H, Zhou R, Chen G, Wu X, Zou M, Wang J and Wu X (2021) Isolated systolic and diastolic hypertension by the 2017 American College of Cardiology/American Heart Association guidelines and risk of cardiovascular disease: a large prospective cohort study, Journal of Hypertension, 10.1097/HJH.0000000000002805, 39:8, (1594-1601), Online publication date: 1-Aug-2021. Li W, Chen D, Liu S, Wang X, Chen X, Chen J, Ma J, Song F, Li H, Yan S, Yin X, Cao S, Gong Y, Liu J, Yue W, Yan F, Lv C, Wang Z and Lu Z (2021)(2021)(2021) The Rates and the Determinants of Hypertension According to the 2017 Definition of Hypertension by ACC/AHA and 2014 Evidence-Based Guidelines Among Population Aged ≥40 Years Old, Global Heart, 10.5334/gh.914, 16:1, Online publication date: 4-May-2021., Online publication date: 4-May-2021., . Yan Y, Ma Q, Liao Y, Chen C, Hu J, Zheng W, Chu C, Wang K, Sun Y, Zou T, Wang Y and Mu J (2021) Blood pressure and long‐term subclinical cardiovascular outcomes in low‐risk young adults: Insights from Hanzhong adolescent hypertension cohort, The Journal of Clinical Hypertension, 10.1111/jch.14225, 23:5, (1020-1029), Online publication date: 1-May-2021. Erlic Z, Reel P, Reel S, Amar L, Pecori A, Larsen C, Tetti M, Pamporaki C, Prehn C, Adamski J, Prejbisz A, Ceccato F, Scaroni C, Kroiss M, Dennedy M, Deinum J, Langton K, Mulatero P, Reincke M, Lenzini L, Gimenez-Roqueplo A, Assié G, Blanchard A, Zennaro M, Jefferson E and Beuschlein F (2020) Targeted Metabolomics as a Tool in Discriminating Endocrine From Primary Hypertension, The Journal of Clinical Endocrinology & Metabolism, 10.1210/clinem/dgaa954, 106:4, (e1111-e1128), Online publication date: 25-Mar-2021. Liu Y, Mi Y, Zhang B, Wang H, Yu J, Pan X, Wang C and Tian Q (2021) The Impact of Hypertension Definition Based on Two-visit Strategy on Estimate of Hypertension Burden: Results From the China Health and Nutrition Survey 1989–2011, Journal of Epidemiology, 10.2188/jea.JE20190163, 31:3, (180-186), Online publication date: 5-Mar-2021. Wang J, Li Y, Chia Y, Cheng H, Minh H, Siddique S, Sogunuru G, Tay J, Teo B, Tsoi K, Turana Y, Wang T, Zhang Y and Kario K (2021) Telemedicine in the management of hypertension: Evolving technological platforms for blood pressure telemonitoring, The Journal of Clinical Hypertension, 10.1111/jch.14194, 23:3, (435-439), Online publication date: 1-Mar-2021. Kario K, Hoshide S, Chia Y, Buranakitjaroen P, Siddique S, Shin J, Turana Y, Park S, Tsoi K, Chen C, Cheng H, Fujiwara T, Li Y, Huynh V, Nagai M, Nailes J, Sison J, Soenarta A, Sogunuru G, Sukonthasarn A, Tay J, Teo B, Verma N, Wang T, Zhang Y and Wang J (2020) Guidance on ambulatory blood pressure monitoring: A statement from the HOPE Asia Network, The Journal of Clinical Hypertension, 10.1111/jch.14128, 23:3, (411-421), Online publication date: 1-Mar-2021. Xiong P, Liu Z, Xiong M and Xie F (2020) Prevalence of high blood pressure under 2017 ACC/AHA guidelines: a systematic review and meta-analysis, Journal of Human Hypertension, 10.1038/s41371-020-00454-8, 35:3, (193-206), Online publication date: 1-Mar-2021. Campbell N, Schutte A, Varghese C, Ordunez P, Zhang X, Khan T, Sharman J, Whelton P, Parati G, Weber M, Orías M, Jaffe M, Moran A, Plavnik F, Ram V, Brainin M, Owolabi M, Ramirez A, Barbosa E, Bortolotto L and Lackland D (2021) Chamado à ação de São Paulo para prevenção e controle da hipertensão arterial, 2020, Revista Panamericana de Salud Pública, 10.26633/RPSP.2021.27, 45, (1), Online publication date: 26-Feb-2021. Campbell N, Schutte A, Varghese C, Ordunez P, Zhang X, Khan T, Sharman J, Whelton P, Parati G, Weber M, Orías M, Jaffe M, Moran A, Plavnik F, Ram V, Brainin M, Owolabi M, Ramirez A, Barbosa E, Bortolotto L and Lackland D (2021) Llamado a la acción de San Pablo para la prevención y el control de la hipertensión arterial, 2020, Revista Panamericana de Salud Pública, 10.26633/RPSP.2021.26, 45, (1), Online publication date: 26-Feb-2021. Zheng L, Dai Y, Fu P, Yang T, Xie Y, Zheng J, Gao J and Niu T (2020) Secular trends of hypertension prevalence based on 2017 ACC/AHA and 2018 Chinese hypertension guidelines: Results from CHNS data (1991‐2015), The Journal of Clinical Hypertension, 10.1111/jch.14060, 23:1, (28-34), Online publication date: 1-Jan-2021. Wang S, Xu J, Hu X and Cui J (2021) Acupuncture combined with western medicine for the treatment of hypertension, Medicine, 10.1097/MD.0000000000026412, 100:25, (e26412) Han M, Yu Q, Tafesh Z and Pyrsopoulos N (2020) Diversity in NAFLD: A Review of Manifestations of Nonalcoholic Fatty Liver Disease in Different Ethnicities Globally, Journal of Clinical and Translational Hepatology, 10.14218/JCTH.2020.00082, 000:000, (1-10), Online publication date: 14-Dec-2020., Online publication date: 28-Dec-2021. Abariga S, Al Kibria G and Albrecht J (2020) Impact of the 2017 American College of Cardiology/American Heart Association Guidelines on Prevalence of Hypertension in Ghana, The American Journal of Tropical Medicine and Hygiene, 10.4269/ajtmh.19-0272, 102:6, (1425-1431), Online publication date: 3-Jun-2020. Tamura K, Yamaji T, Azushima K and Wakui H (2020) Mass clinical survey as a possible population strategy for the better control of hypertension in Japan, Hypertension Research, 10.1038/s41440-019-0381-9, 43:5, (463-465), Online publication date: 1-May-2020. Han M, Chen Q, Liu L, Li Q, Ren Y, Zhao Y, Liu D, Zhang D, Liu F, Chen X, Cheng C, Guo C, Zhou Q, Tian G, Qie R, Huang S, Wu X, Liu Y, Li H, Sun X, Lu J, Hu D and Zhang M (2020) Stage 1 hypertension by the 2017 American College of Cardiology/American Heart Association hypertension guidelines and risk of cardiovascular disease events: systematic review, meta-analysis, and estimation of population etiologic fraction of prospective cohort studies, Journal of Hypertension, 10.1097/HJH.0000000000002321, 38:4, (573-578), Online publication date: 1-Apr-2020. Weller R, Wang Y, He J, Maddux F, Usvyat L, Zhang H, Feelisch M and Kotanko P (2020) Does Incident Solar Ultraviolet Radiation Lower Blood Pressure?, Journal of the American Heart Association, 9:5, Online publication date: 3-Mar-2020. Liu N, Yang J, Meng R, Pan X, Zhang X, He M, Li H, Gao Y, Xiang Y, Shu X, Zheng W, Wu T, Yu D and Pan A (2019) Associations of blood pressure categories defined by 2017 ACC/AHA guidelines with mortality in China: Pooled results from three prospective cohorts, European Journal of Preventive Cardiology, 10.1177/2047487319862066, 27:4, (345-354), Online publication date: 1-Mar-2020. Wang J, Chia Y, Chen C, Park S, Hoshide S, Tomitani N, Kabutoya T, Shin J, Turana Y, Soenarta A, Tay J, Buranakitjaroen P, Nailes J, Van Minh H, Siddique S, Sison J, Sogunuru G, Sukonthasarn A, Teo B, Verma N, Zhang Y, Wang T and Kario K (2020) What is new in the 2018 Chinese hypertension guideline and the implication for the management of hypertension in Asia?, The Journal of Clinical Hypertension, 10.1111/jch.13803, 22:3, (363-368), Online publication date: 1-Mar-2020. Kario K (2020) The HOPE Asia Network activity for “zero” cardiovascular events in Asia: Overview 2020, The Journal of Clinical Hypertension, 10.1111/jch.13750, 22:3, (321-330), Online publication date: 1-Mar-2020. Chia Y, Kario K, Turana Y, Nailes J, Tay J, Siddique S, Park S, Shin J, Buranakitjaroen P, Chen C, Divinagracia R, Hoshide S, Minh H, Sison J, Soenarta A, Sogunuru G, Sukonthasarn A, Teo B, Verma N, Zhang Y, Wang T and Wang J (2019) Target blood pressure and control status in Asia, The Journal of Clinical Hypertension, 10.1111/jch.13714, 22:3, (344-350), Online publication date: 1-Mar-2020. Wang M, Wu T, Yu C, Gao W, Lv J, Wu Y, Qin X, Tang X, Gao P, Zhan S, Cao W, Zhao Q, Huang S, Yang D, Li L and Hu Y (2020) Association between blood pressure levels and cardiovascular deaths: a 20-year follow-up study in rural China, BMJ Open, 10.1136/bmjopen-2019-035190, 10:2, (e035190), Online publication date: 1-Feb-2020. Campbell N, Schutte A, Varghese C, Ordunez P, Zhang X, Khan T, Sharman J, Whelton P, Parati G, Weber M, Orías M, Jaffe M, Moran A, Liane Plavnik F, Ram V, Brainin M, Owolabi M, Ramirez A, Barbosa E, Bortolotto L and Lackland D (2019) São Paulo call to action for the prevention and control of high blood pressure: 2020, The Journal of Clinical Hypertension, 10.1111/jch.13741, 21:12, (1744-1752), Online publication date: 1-Dec-2019. Aburto T, Gordon‐Larsen P, Poti J, Howard A, Adair L, Avery C and Popkin B (2019) Is a Hypertension Diagnosis Associated With Improved Dietary Outcomes Within 2 to 4 Years? A Fixed‐Effects Analysis From the China Health and Nutrition Survey, Journal of the American Heart Association, 8:21, Online publication date: 5-Nov-2019. Xie Y, Gao J, Guo R, Zheng J, Wang Y, Dai Y, Sun Z, Xing L, Zhang X, Sun Y and Zheng L (2019) Stage 1 hypertension defined by the 2017 ACC/AHA guideline predicts future cardiovascular events in elderly Chinese individuals, The Journal of Clinical Hypertension, 10.1111/jch.13706, 21:11, (1637-1644), Online publication date: 1-Nov-2019. Wang Q, Chao H, Zheng S, Tan I, Butlin M, Avolio A and Zuo J (2019) Impact of new hypertension guidelines on target organ damage screening in a Shanghai community‐dwelling population, The Journal of Clinical Hypertension, 10.1111/jch.13677, 21:10, (1450-1455), Online publication date: 1-Oct-2019. Ji C, Wu S, Shi J, Huang Z, Zhu C, Du X, Chen S, Wang G and Cui W (2019) Stage 1 hypertension defined by the 2017 ACC/AHA Hypertension Guidelines and Risk of Cardiovascular Events: a Cohort Study from Northern China, Hypertension Research, 10.1038/s41440-019-0268-9, 42:10, (1606-1615), Online publication date: 1-Oct-2019. Kario K, Shin J, Chen C, Buranakitjaroen P, Chia Y, Divinagracia R, Nailes J, Hoshide S, Siddique S, Sison J, Soenarta A, Sogunuru G, Tay J, Teo B, Turana Y, Zhang Y, Park S, Van Minh H and Wang J (2019) Expert panel consensus recommendations for ambulatory blood pressure monitoring in Asia: The HOPE Asia Network, The Journal of Clinical Hypertension, 10.1111/jch.13652, 21:9, (1250-1283), Online publication date: 1-Sep-2019. Tamura K, Waki K, Kawai Y, Ueda E, Ishii T and Wakui H (2019) Possible interesting link between dipping status and morning surge for subclinical target organ damage in hypertension, The Journal of Clinical Hypertension, 10.1111/jch.13637, 21:9, (1295-1297), Online publication date: 1-Sep-2019. Zhao P, Liu J, Wang C, Zhao W, Zhang Y, Gu H, Tu J, Wang J and Ning X (2019) Strict target blood pressure management for reducing the stroke risk according to 2017 ACC/AHA blood pressure guideline, Aging, 10.18632/aging.102207, 11:16, (6522-6534), Online publication date: 27-Aug-2019. Aydogan U, Doganer Y, Ebiloglu A, Gok D, Cirpan E and Saglam K (2019) Projection of new thresholds for hypertension to outpatient clinic patients and impact of risk factors: a cross-sectional study, Sao Paulo Medical Journal, 10.1590/1516-3180.2019.0111220719, 137:4, (356-362) Kim S, Chang Y, Kang J, Cho A, Cho J, Hong Y, Zhao D, Ahn J, Shin H, Guallar E, Ryu S and Sung K (2019) Relationship of the Blood Pressure Categories, as Defined by the ACC/AHA 2017 Blood Pressure Guidelines, and the Risk of Development of Cardiovascular Disease in Low‐Risk Young Adults: Insights From a Retrospective Cohort of Young Adults, Journal of the American Heart Association, 8:11, Online publication date: 4-Jun-2019. Fernandes M and Olde Rikkert M (2019) The new US and European guidelines in hypertension: A multi-dimensional analysis, Contemporary Clinical Trials, 10.1016/j.cct.2019.04.008, 81, (44-54), Online publication date: 1-Jun-2019. Ni Z, He J, Wang J, Cao J, Yang Q, Wu B and Shaw R (2019) Chinese Physicians’ Perspectives on the 2017 American College of Cardiology/American Heart Association Hypertension Guideline: A Mobile App-Based Survey, High Blood Pressure & Cardiovascular Prevention, 10.1007/s40292-019-00321-9, 26:3, (247-257), Online publication date: 1-Jun-2019. Kuipers A, Miljkovic I, Barinas-Mitchell E, Cvejkus R, Bunker C, Wheeler V and Zmuda J (2019) Arterial stiffness and hypertension status in Afro-Caribbean men, Journal of Hypertension, 10.1097/HJH.0000000000001909, 37:3, (546-554), Online publication date: 1-Mar-2019. Chen C, Guo C, Gao J, Shi K, Cheng J, Zhang J, Chen S, Liu Y and Liu A (2019) Vasorelaxant and antihypertensive effects of Tianshu Capsule on rats: An in vitro and in vivo approach, Biomedicine & Pharmacotherapy, 10.1016/j.biopha.2018.12.061, 111, (188-197), Online publication date: 1-Mar-2019. Garies S, Hao S, McBrien K, Williamson T, Peng M, Khan N, Padwal R, Quan H and Leung A (2019) Prevalence of Hypertension, Treatment, and Blood Pressure Targets in Canada Associated With the 2017 American College of Cardiology and American Heart Association Blood Pressure Guidelines, JAMA Network Open, 10.1001/jamanetworkopen.2019.0406, 2:3, (e190406) Deng Y, Tan X, Li M, Wang W and Wang Y (2018) Angiotensin-Converting Enzyme 2 in the Rostral Ventrolateral Medulla Regulates Cholinergic Signaling and Cardiovascular and Sympathetic Responses in Hypertensive Rats, Neuroscience Bulletin, 10.1007/s12264-018-0298-3, 35:1, (67-78), Online publication date: 1-Feb-2019. Nakagawa N and Hasebe N (2019) Impact of the 2017 American College of Cardiology/American Heart Association Blood Pressure Guidelines on the Next Blood Pressure Guidelines in Asia, Current Hypertension Reports, 10.1007/s11906-019-0906-2, 21:1, Online publication date: 1-Jan-2019. Guevara-Cuellar C, Soto V and Molina-Echeverry M (2018) Budget impact analysis of the adoption of new hypertension guidelines in Colombia, Cost Effectiveness and Resource Allocation, 10.1186/s12962-018-0152-5, 16:1, Online publication date: 1-Dec-2018. Feitosa A, Mota‐Gomes M, Miranda R, Barroso W, Barbosa E, Pedrosa R, Oliveira P, Feitosa C, Lima‐Filho J, Sposito A and Nadruz W (2018) Impact of 2017 ACC/AHA hypertension guidelines on the prevalence of white‐coat and masked hypertension: A home blood pressure monitoring study, The Journal of Clinical Hypertension, 10.1111/jch.13422, 20:12, (1745-1747), Online publication date: 1-Dec-2018. Kario K, Tomitani N, Buranakitjaroen P, Chia Y, Park S, Chen C, Divinagracia R, Shin J, Siddique S, Sison J, Ann Soenarta A, Sogunuru G, Tay J, Turana Y, Zhang Y, Nailes J, Wanthong S, Hoshide S, Matsushita N, Kanegae H and Wang J (2018) Home blood pressure control status in 2017‐2018 for hypertension specialist centers in Asia: Results of the Asia [email protected] study, The Journal of Clinical Hypertension, 10.1111/jch.13415, 20:12, (1686-1695), Online publication date: 1-Dec-2018. Tian J, Sheng C, Sun W, Song X, Wang H, Li Q, Li W and Wang W (2018) Effects of High Blood Pressure on Cardiovascular Disease Events Among Chinese Adults With Different Glucose Metabolism, Diabetes Care, 10.2337/dc18-0918, 41:9, (1895-1900), Online publication date: 1-Sep-2018. Qi Y, Han X, Zhao D, Wang W, Wang M, Sun J, Liu J, Li Y, Gao S, Hao Y, Deng Q and Liu J (2018) Long-Term Cardiovascular Risk Associated With Stage 1 Hypertension Defined by the 2017 ACC/AHA Hypertension Guideline, Journal of the American College of Cardiology, 10.1016/j.jacc.2018.06.056, 72:11, (1201-1210), Online publication date: 1-Sep-2018. Jennings G, Kingwell B and Hoare E (2018) Potential implications of the new American hypertension guidelines in Australia, Medical Journal of Australia, 10.5694/mja18.00104, 209:3, (108-109), Online publication date: 1-Aug-2018. Kario K and Wang J (2018) Could 130/80 mm Hg Be Adopted as the Diagnostic Threshold and Management Goal of Hypertension in Consideration of the Characteristics of Asian Populations?, Hypertension, 71:6, (979-984), Online publication date: 1-Jun-2018.Campbell N and Zhang X (2018) Hypertension in China, Circulation, 137:22, (2357-2359), Online publication date: 29-May-2018. Tamura K, Haruhara K, Azushima K, Iwamoto T and Wakui H (2018) Possible interesting link between Janus kinase 2 mutation and renovascular hypertension, The Journal of Clinical Hypertension, 10.1111/jch.13274, 20:4, (805-806), Online publication date: 1-Apr-2018. February 6, 2018Vol 137, Issue 6 Advertisement Article InformationMetrics © 2018 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.117.032890PMID: 29431657 Originally publishedFebruary 6, 2018 Keywordshypertensionblood pressureguidelinetherapeuticsdiagnosisPDF download Advertisement SubjectsHypertension
Referência(s)