BELGIUM 27th !!!
1) HTA DE GRADE 3 = TOUJOURS RISQUE > ELEVE
4
3
2) PREVENTION SECONDAIRE ou
DIABETE + ATTEINTE ‘ORGANE CIBLE’/FACTEUR DE RISQUE
= RISQUE ELEVE PEU IMPORTE LA PA
3) Si PAS >140 et/ou 90 mmHg et
 >3 facteurs de risque CV
 ou atteinte ‘organe cible’
 ou diabète
= RISQUE ELEVE
LIFE EXPECTANCY AT 60 YRS IN 2012
Ph van de Borne, L Missault, A Persu, W Van Mieghem
for the COME STAI INVESTIGATORS
RESULTS (2): Nr of medications reported
in n:7961 patients (0 vs. 1 vs. 2 or more drugs)
Parameters
>2
1
medications
medication
0
medication
Systolic BP
(mmHg)
139±19
139±18
143±21*
Diastolic BP
(mmHg)
80±11
81±11
83±13*
Age
(years)
68±12
62±13
55±15*
Heart rate
(bpm)
72±10
73±9
75±10*
Body mass
index (kg/m²)
29.0±5.8
27.2±5.0
26.7±5.2*
S: systolic; D: diastolic; BP: Blood pressure; bpm: beat per minute; * p<0.0001
Less intense treatment in the elderly :
Among 495 patients aged ≥80 years,
and SBP> 140 mmHg, therapy was
intensified:
in 57% when SBP > 160 mmHg
(n=130)
in 17% when 140 <SBP<159 mmHg*
(n=365)
*p Chi² <0.0001
Blood pressure in
mm Hg
ESH/ESC
2013[3]
ASH/ISH
2014 [4]
Go A. et al.
AHA/ACC/CDC 2013 [5]
Definition of
Hypertension
≥140/90
≥140/90
≥140/90
2014 Hypertension
guidelines, US “JNC 8”
[6]
Not addressed
Drug therapy in low risk
patients after nonpharmacologic treatment
≥140/90
≥140/90
≥140/90
< 60 y. ≥140/90
Beta-blockers as first line
drug
Yes
No
(Step 4)
No
(Step 3)
No
(Step 4)
Diuretic
thiazides
chlorthalidone,
indapamide
If markedly elevated
BP
<140/90
Elderly < 80 y.
SBP 140-150
SBP <140 in fit
patients
Elderly ≥ 80 y.
SBP 140-150
< 140/85
thiazides
chlorthalidone
indapamide
≥160/100
thiazides
thiazides
chlorthalidone,
indapamide
≥160/100
Initiate drug therapy with two
drugs
Blood pressure targets
Blood Pressure target in
patients with diabetes
mellitus
≥ 60 y. ≥150/90
<140/90
≥ 80 y.
< 150/90
<140/90
≥160/100
<140/90
Lower targets may be
appropriate in some
patients, including the
elderly
<140/90
Lower targets may be
considered
< 60 y.
<140/90
≥ 60 y. <150/90
<140 /90