We searched PubMed and MEDLINE for articles published from Jan 1, 2010, to Oct 25, 2020. We used the search terms “blood pressure”, “hypertension”, “arterial hypertension”, in combination with the terms “guidelines”, “chronotropy”, “resistant hypertension”, “diabetes”, “ambulatory blood pressure monitoring”, “home blood pressure measurement”, “digital health”, “mobile health”, “lifetime risk”, “prospective studies”, “epidemiology”, “population”, “lifetime blood pressure”, “diet”, “lifestyle”,
SeminarArterial hypertension
Section snippets
Epidemiology
Hypertension is one of the most important modifiable risk factors for cardiovascular disease and one of the largest contributors to morbidity and mortality worldwide. In a systematic analysis done for the Global Burden of Disease Study 2017, high systolic blood pressure (SBP) was the leading risk factor for mortality (10·4 million deaths) and disability-adjusted life-years (218 million).1 In a study including 8·69 million participants from 154 countries, it was estimated that between 1990 and
Pathophysiology
Hypertension can be classified as essential or secondary, with most patients having essential hypertension.13 The cause of hypertension is multifactorial in nature, with environment, genetics, and social determinants having the potential to contribute to its development.13 A better understanding of the interplay between these components has continued to unfold.14
Increasing knowledge has also been gathered on the pathophysiology of hypertension. Besides the traditional environmental factors (eg,
Blood pressure measurements
Accurate and reliable blood pressure measurements are essential for the diagnosis of hypertension. Blood pressure changes constantly in response to endogenous factors and exogenous stimuli; therefore, standardisation is essential for an accurate measurement.40 Unfortunately, the problem of unstandardised measurements has persisted for decades, despite efforts in education and simplification of the measurement process. The widespread availability of non-validated blood pressure devices might
Non-pharmacological and pharmacological management of hypertension
Within the past 4 years, four major guideline writing entities have published updates regarding hypertension management: the ACC–AHA, the ESC–ESH, the National Institute for Health and Care Excellence (NICE), and, most recently, the ISH guidelines. The intent of the ISH guideline was to be written in a manner that would be easy to use and apply in low-income, middle-income, and high-income countries.50
Each set of guidelines notes that sodium restriction in patients with hypertension is needed
Future perspectives
For a largely controllable condition, the rates of awareness, treatment, and control of hypertension are disappointingly low. There is room for improvement among the various levels of health care and throughout the process of patient screening, diagnosis, treatment, and follow-up. Previous initiatives have reviewed the necessary actions to improve management of blood pressure worldwide.44
Medications available for hypertension management have not changed profoundly throughout previous decades.
Search strategy and selection criteria
Declaration of interests
IS reports consulting fees, speaker fees, and travel grants from Amgen, AstraZeneca, Boston Scientific, Daiichi Sankyo, Medtronic, Novartis, Recordati, Sanofi, and Servier. All other authors declare no competing interests.
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Prevalence, awareness, treatment, and control of hypertension in China: data from 1·7 million adults in a population-based screening study (China PEACE Million Persons Project)
Lancet
(2017) - et al.
Prevalence of elevated blood pressure in children and adolescents in Africa: a systematic review and meta-analysis
Lancet Public Health
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Hypertension in developing countries
Lancet
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Prevention and control of hypertension: JACC Health Promotion Series
J Am Coll Cardiol
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Use of renin-angiotensin-aldosterone system inhibitors and risk of COVID-19 requiring admission to hospital: a case-population study
Lancet
(2020) - et al.
Joint HFSA/ACC/AHA Statement addresses concerns re: using RAAS antagonists in COVID-19
J Card Fail
(2020) - et al.
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) - et al.
2017 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
J Am Coll Cardiol
(2018) - et al.
Quarter-dose quadruple combination therapy for initial treatment of hypertension: placebo-controlled, crossover, randomised trial and systematic review
Lancet
(2017) - et al.
A review of hypertension management in Black male patients
Mayo Clin Proc
(2020)