Hypertension clinical guideline 2000.

OUTCOMES: Extensive data from many randomised controlled trials have shown the benefit of treating hypertension. The target blood pressure (BP) for antihypertensive management should be systolic < 140 mmHg and diastolic < 90 mmHg, with minimal or no drug side-effects. However, a lesser reduction will elicit benefit, although this is not optimal. The reduction of BP in the elderly and in those with severe hypertension should be achieved gradually over 6 months. Stricter BP control is required for patients with end-organ damage, coexisting risk factors and co-morbidity, e.g. diabetes mellitus. Coexistent risk factors should also be controlled. BENEFITS: Reduction in risk of stroke, cardiac failure, renal insufficiency and probably coronary artery disease. The major precautions and contraindications to each antihypertensive drug recommended are listed. RECOMMENDATIONS: Correct BP measurement procedure is described. Evaluation of cardiovascular risk factors and recommendations for antihypertensive therapy are stipulated. The total cardiovascular disease risk profile should be determined for all patients and this should inform management strategies. Lifestyle modification and patient education play an essential role in the management strategy. DRUG THERAPY: First line--low-dose diuretics; second line--add one of the following: reserpine, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors or calcium channel blockers; third line--add another second-line drug or hydralazine or an alpha-blocker. The guideline includes management of specific situations, e.g. hypertensive emergency or urgency, severe hypertension with target organ damage and refractory hypertension (BP > 160/95 mmHg on triple therapy), hypertension in diabetes mellitus, etc. VALIDATION: The guideline was developed by the Executive Committee of the Southern African Hypertension Society with consensus meeting endorsement, and is endorsed by the South African Medical Association Guideline Commitee.