Korean Circ J.  2020 Jun;50(6):476-484. 10.4070/kcj.2019.0338.

Updated Reasons and Clinical Implications of New Korean Hypertension Guidelines for Cardiologists

Affiliations
  • 1Division of Cardiology, Department of Internal Medicine, Hanyang University Hospital, Seoul, Korea
  • 2Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea

Abstract

Leaving behind substantial reflections or skepticisms on the shortage of evidences about blood pressure (BP) thresholds for antihypertensive drug therapy and target BPs, major hypertensive guidelines including Korean hypertension guidelines were recently updated for earlier and more intensive control of BP. Because hypertension is one of the major risk factors for death, stroke, cardiovascular (CV) disease, heart failure, and cognitive impairment, substantial improvement of hypertension management is necessary to reduce disease and socioeconomic burdens and to promote CV health. Theoretically, earlier intervention in terms of age and BP level and thorough control of BP into within normal range would prevent or delay major adverse CV events. Revised hypertension guidelines were developed by the American College of Cardiology/American Heart Association, Korean Society of Hypertension, European Society of Cardiology/European Society of Hypertension, and Japanese Society of Hypertension in order. In this article, recent updates and clinical significances of the Korean hypertension guidelines will be discussed with comparison of foreign hypertension guidelines and considerable changes in the management of hypertension will be introduced for cardiologists and general practitioners.

Keyword

Hypertension; Practice guideline; Risk factors; Antihypertensive agents

Figure

  • Figure 1 Trends of hypertension management in Korea.Level of hypertension management in Korea improved rapidly since 1998 over a decade but it has been stagnant over another decade since 2007. Data are presented as age-standardized proportion for the adults aged 30 or higher in Korean National Health and Nutritional Examination Survey.

  • Figure 2 Clinical algorithm to achieve target BP according to the presence of complicated diseases or patient risk profiles. In complicated patients, one or more antihypertensive medications are already initiated regardless of level of BP according to the standard treatment guidelines so that further titration can be decided by recommended target BP.BP = blood pressure; CKD = chronic kidney disease; CVD = cardiovascular disease; DM = diabetes mellitus.*BP lowering drug treatment and lifestyle modifications are recommended for frail elderly patients or very old patients (≥80 years) when SBP is ≥160 mmHg.


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Reference

1. Shin J, Park JB, Kim KI, et al. 2013 Korean Society of Hypertension guidelines for the management of hypertension: part I-epidemiology and diagnosis of hypertension. Clin Hypertens. 2015; 21:1. PMID: 26893915.
Article
2. Shin J, Park JB, Kim KI, et al. 2013 Korean Society of Hypertension guidelines for the management of hypertension. Part II-treatments of hypertension. Clin Hypertens. 2015; 21:2. PMID: 26893916.
Article
3. Shin J, Park JB, Kim KI, et al. 2013 Korean Society of Hypertension guidelines for the management of hypertension: part III-hypertension in special situations. Clin Hypertens. 2015; 21:3. PMID: 26893917.
Article
4. SPRINT Research Group, Wright JT Jr, Williamson JD, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015; 373:2103–2116. PMID: 26551272.
Article
5. Whelton PK, Carey RM, Aronow WS, 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. Circulation. 2018; 138:e484–e594. PMID: 30354654.
6. Nerenberg KA, Zarnke KB, Leung AA, et al. Hypertension Canada's 2018 guidelines for diagnosis, risk assessment, prevention, and treatment of hypertension in adults and children. Can J Cardiol. 2018; 34:506–525. PMID: 29731013.
7. Kim HC, Ihm SH, Kim GH, et al. 2018 Korean Society of Hypertension guidelines for the management of hypertension: part I-epidemiology of hypertension. Clin Hypertens. 2019; 25:16. PMID: 31388451.
Article
8. Lee HY, Shin J, Kim GH, et al. 2018 Korean Society of Hypertension guidelines for the management of hypertension: part II-diagnosis and treatment of hypertension. Clin Hypertens. 2019; 25:20. PMID: 31388453.
Article
9. Kim KI, Ihm SH, Kim GH, et al. 2018 Korean Society of Hypertension guidelines for the management of hypertension: part III-hypertension in special situations. Clin Hypertens. 2019; 25:19. PMID: 31388452.
Article
10. Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018; 39:3021–3104. PMID: 30165516.
11. Umemura S, Arima H, Arima S, et al. The Japanese Society of Hypertension guidelines for the management of hypertension (JSH 2019). Hypertens Res. 2019; 42:1235–1481. PMID: 31375757.
12. Korean Society Hypertension (KSH). Hypertension Epidemiology Research Working Group. Kim HC, Cho MC. Korea hypertension fact sheet 2018. Clin Hypertens. 2018; 24:13. PMID: 30288297.
Article
13. Williams B, Mancia G, Spiering W, et al. 2018 Practice guidelines for the management of arterial hypertension of the ESH/ESC: task force for the management of arterial hypertension. J Hypertens. 2018; 36:2284–2309. PMID: 30379783.
14. Kimm H, Mok Y, Lee SJ, Lee S, Back JH, Jee SH. The J-curve between diastolic blood pressure and risk of all-cause and cardiovascular death. Korean Circ J. 2018; 48:36–47. PMID: 29322696.
Article
15. Huang Y, Wang S, Cai X, et al. Prehypertension and incidence of cardiovascular disease: a meta-analysis. BMC Med. 2013; 11:177. PMID: 23915102.
Article
16. Martin JF, Martin LN, Cipullo JP. Pharmacologic treatment for prehypertension: to treat or not to treat? Recent Patents Cardiovasc Drug Discov. 2009; 4:133–141.
Article
17. Pimenta E, Oparil S. Prehypertension: epidemiology, consequences and treatment. Nat Rev Nephrol. 2010; 6:21–30. PMID: 19918256.
Article
18. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002; 360:1903–1913. PMID: 12493255.
19. Shin J, Park SH, Kim JH, et al. Discordance between ambulatory versus clinic blood pressure according to global cardiovascular risk group. Korean J Intern Med. 2015; 30:610–619. PMID: 26354055.
Article
20. Jung KJ, Jang Y, Oh DJ, et al. The ACC/AHA 2013 pooled cohort equations compared to a Korean risk prediction model for atherosclerotic cardiovascular disease. Atherosclerosis. 2015; 242:367–375. PMID: 26255683.
Article
21. Lee JH, Kim KI, Cho MC. Current status and therapeutic considerations of hypertension in the elderly. Korean J Intern Med. 2019; 34:687–695. PMID: 31272140.
Article
22. Ettehad D, Emdin CA, Kiran A, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016; 387:957–967. PMID: 26724178.
Article
23. Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering on outcome incidence in hypertension: 7. Effects of more vs. less intensive blood pressure lowering and different achieved blood pressure levels - updated overview and meta-analyses of randomized trials. J Hypertens. 2016; 34:613–622. PMID: 26848994.
24. Kjeldsen SE, Mancia G. The un-observed automated office blood pressure measurement technique used in the SPRINT study points to a standard target office systolic blood pressure <140 mmHg. Curr Hypertens Rep. 2017; 19:3. PMID: 28091868.
Article
25. Xie X, Atkins E, Lv J, et al. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis. Lancet. 2016; 387:435–443. PMID: 26559744.
Article
26. Bangalore S, Toklu B, Gianos E, et al. Optimal systolic blood pressure target after SPRINT: insights from a network meta-analysis of randomized trials. Am J Med. 2017; 130:707–719.e8. PMID: 28109971.
Article
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