Guideline for the diagnosis and management of hypertension in adults — 2016

TLDR

The Australian hypertension guideline, updated in 2010, incorporates evidence that lowering BP in mild hypertension reduces stroke, cardiovascular death, and all‑cause mortality, and recommends treatment decisions be based on absolute cardiovascular risk and end‑organ damage. The guideline recommends close follow‑up when targeting systolic BP <120 mmHg to monitor for adverse effects such as hypotension, syncope, electrolyte disturbances, and acute kidney injury. The guideline recommends initiating antihypertensive therapy for low‑risk patients with BP ≥160/100 mmHg and for moderate‑risk patients with systolic ≥140 mmHg or diastolic ≥90 mmHg, targeting <140/90 mmHg (or lower if tolerated), using ambulatory or home monitoring when clinic BP ≥140/90 mmHg, and aiming for <120 mmHg systolic in high‑risk populations, a strategy supported by trials showing improved outcomes and reduced mortality despite some increased adverse events.

Abstract

The National Heart Foundation of Australia has updated the Guide to management of hypertension 2008: assessing and managing raised blood pressure in adults (updated December 2010). Main recommendations For patients at low absolute cardiovascular disease risk with persistent blood pressure (BP) ≥ 160/100 mmHg, start antihypertensive therapy. The decision to treat at lower BP levels should consider absolute cardiovascular disease risk and/or evidence of end-organ damage, together with accurate BP assessment. For patients at moderate absolute cardiovascular disease risk with persistent systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg, start antihypertensive therapy. Treat patients with uncomplicated hypertension to a target BP of < 140/90 mmHg or lower if tolerated. Changes in management as a result of the guideline Ambulatory and/or home BP monitoring should be offered if clinic BP is ≥ 140/90 mmHg, as out-of-clinic BP is a stronger predictor of outcome. In selected high cardiovascular risk populations, aiming for a target of < 120 mmHg systolic can improve cardiovascular outcomes. If targeting < 120 mmHg, close follow-up is recommended to identify treatment-related adverse effects including hypotension, syncope, electrolyte abnormalities and acute kidney injury. Why the changes have been made A 2015 meta-analysis of patients with uncomplicated mild hypertension (systolic BP range, 140–159 mmHg) demonstrated that BP-lowering therapy is beneficial (reduced stroke, cardiovascular death and all-cause mortality). A 2015 trial comparing lower with higher blood pressure targets in selected high cardiovascular risk populations found improved cardiovascular outcomes and reduced mortality, with an increase in some treatment-related adverse events.