BELGIUM 27th !!!

1) HTA DE GRADE 3 = TOUJOURS RISQUE > ELEVE

2) PREVENTION SECONDAIRE ou DIABETE + ATTEINTE ‘ORGANE CIBLE’/FACTEUR DE RISQUE

= RISQUE ELEVE PEU IMPORTE LA PA

4

3

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 Mieghemfor the COME STAI INVESTIGATORS

Parameters > 2 medications

1 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

RESULTS (2): Nr of medications reportedin n:7961 patients (0 vs. 1 vs. 2 or more drugs)

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]

2014 Hypertension guidelines, US “JNC 8”

[6]Definition ofHypertension

 ≥140/90  ≥140/90 ≥140/90  Not addressed

Drug therapy in low risk patients after non-

pharmacologic treatment

 ≥140/90  ≥140/90  ≥140/90  < 60 y. ≥140/90

≥ 60 y. ≥150/90  

Beta-blockers as first line drug

 Yes  No(Step 4)

No(Step 3)

No (Step 4)

Diuretic thiazideschlorthalidone,

indapamide

thiazides chlorthalidone

indapamide

 thiazides thiazides chlorthalidone,

indapamideInitiate drug therapy with

two drugsIf markedly elevated BP

≥160/100 ≥160/100 ≥160/100

Blood pressure targets <140/90 Elderly < 80 y. SBP 140-150

SBP <140 in fit patients

Elderly ≥ 80 y. SBP 140-150

<140/90

≥ 80 y. < 150/90

 

<140/90Lower targets may be appropriate in some

patients, including the elderly

< 60 y. <140/90

≥ 60 y. <150/90   

Blood Pressure target in patients with diabetes

mellitus

< 140/85 <140/90 <140/90 Lower targets may be

considered

<140 /90