Hypertension Fo

New guidelines for the management of arterial hypertension

Jan. 3, 2014
New guidelines for the management of hypertension propose that people age 60 or older might be able to withstand higher blood pressure readings than originally thought. Maria Perno Goldie, RDH, MS, takes a look at the new guidelines.
New guidelines for the management of hypertension propose that people 60 or older might be able to tolerate higher blood pressure readings than originally thought.(1) Hypertension, which can lead to strokes, heart attack, kidney failure, and death, is traditionally treated with medication and diet. The goal of physicians is to have their patient's blood pressure below 140 (systolic)/90 (diastolic). However, after reviewing a multitude of evidence, a committee of experts now pronounces the systolic number, especially in older people, can be higher at 150/90.

The new guidelines base recommendations on appropriately conducted studies identified from an extensive review of the literature, to consider, as the highest priority, data from randomized, controlled trials (RCTs) and their meta-analyses. However, they do not disregard the results of observational and other studies of appropriate scientific caliber.

The levels of evidence are as follows.

• Level of evidence A - Data derived from multiple randomized clinical trials or meta-analyses.
• Level of evidence B - Data derived from a single randomized clinical trial or large non-randomized studies.
• Level of evidence C - Consensus of opinion of the experts and/or small studies, retrospective studies, registries.

Based on the new guidelines, it might mean that many of these patients who were on medication would no longer need to be taking pharmaceuticals. It has been estimated that millions of people could be affected by the new guidelines.

The committee was asked to update the guidelines that have been in place for more than thirty years. They were published online December, 2013, in the Journal of the American Medical Association. The group of seventeen experts found no reason to change any other section of the guidelines.

Treatment strategies include: lifestyle changes; moderation of alcohol consumption; dietary changes; weight reduction; regular physical exercise; and smoking cessation. These broad categories include: salt restriction; moderate consumption of alcohol (different for men and women); increased consumption of vegetables, fruits, and low-fat dairy products; reduction of weight (different for men and women); regular exercise; and cessation of tobacco products.
In addition, there are a range of pharmacological therapies, such as: Beta-blockers; Diuretics; Calcium antagonists; Angiotensin-converting enzyme inhibitors; Renin inhibitors; and others. Because of new evidence on several diagnostic and therapeutic aspects of hypertension, the present guidelines differ in many respects from the previous ones.(2) Several studies are available to show that team-based care can reduce BP by several mmHg more than standard care.(3)

Dental care professionals realize that the key component of any thorough dental hygiene appointment is patient assessment.(4) While there are several tools used for conducting screenings and examinations for oral health, other aspects of patient health that may be related to dental heath are often overlooked. A patient’s blood pressure is one of these parameters. Appropriate monitoring of blood pressure cannot only improve outcomes of dental care but also play a role in improving the overall health of patients.

References 1. The Task Force for the management ofarterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). 2013 ESH/ESC Guidelines for themanagement of arterial hypertension. Journal of Hypertension 2013, 31:1281–1357. 2. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007; 25:1105–1187. 3. Carter BL, Rogers M, Daly J, Zheng S, James PA. The potency ofteambased care interventions for hypertension: a meta-analysis. Arch
Intern Med
2009; 169:1748–1755. 4. http://adctoday.com/sites/default/files/literature/9000_Whitepaper_0002.pdf.

Maria Perno Goldie, RDH, MS

To read previous RDH eVillage FOCUS articles by Maria Perno Goldie, click here.

To read more about hypertension and dental hygiene, click here.