Guidelines

GP Corner	Guidelines	Monitoring Devices	Expert Opinions

·     There is no question that hypertension is one of the worst managed illnesses in the world today.

·     This occurs because many people who suffer from hypertension remain undiagnosed until it is too late.

·    In addition, many patients are not treated to appropriate blood pressure targets and therefore remain at risk for a serious cardiovascular event.

·     It is therefore important that to detect an elevated blood pressure, the measurement should be performed appropriately, and that in the management of hypertension, the best clinical practise is employed at all times.

·      To this end a number of Societies around the world have developed “guidelines for the diagnosis and management of hypertension”.

·     The present section refers you to guidelines developed by expert panels in a number of countries.

·      This includes guidelines developed by the Southern African Hypertension Society (SAHS).

·     As new information is constantly appearing, guidelines are updated at intermittent periods.

·      This page therefore lists and provides an easy method of accessing these guidelines, in order of appearance with the latest information first and the oldest information last.

·    The SAHS guidelines provide a detailed consensus opinion on the diagnosis and management of hypertension in the setting of limited resources.

2011: Guidelines for the Primary Prevention of Stroke 

Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association

Goldstein et al. Stroke 2011;42:517-584.

 Available at http://stroke.ahajournals.org/cgi/content/full/42/2/517

This guideline provides an overview of established and emerging risk factors for stroke based upon current evidence. In addition, based-upon current evidence, this guideline provides recommendations for the reduction of the risk of a first stroke.

2010: Stroke therapy guideline 2010 

South African guideline for management of ischaemic stroke and transient ischaemic attack 2010: A guideline from the South African Stroke Society (SASS) and the SASS Writing Committee.

S Afr Med J 2010;100:747-778.     

In this paper the SASS and SASS Writing Committee update the Stroke Therapy Clinical Guidelines published in 2000. The recommendations made in the guidelines are placed within the current South African context, and the evidence upon which these guidelines is based is graded according to scientific rigour. Importantly, these guidelines cover many aspects of stroke care ranging from primary prevention, acute management, rehabilitation to secondary prevention.

2009: Reappraisal of the European guidelines on hypertension management                                     

Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document.

Mancia et al. J Hypertens 2009;27:2121-2158.  

In this paper a European Task Group has reappraised some of the features of the 2007 European Society of Hypertension and European Society of Cardiology Guidelines based on the outcomes of more recent clinical trials.

 
2009: SEMDSA guidelines for diagnosis and management of type 2 diabetes mellitus

Produced and adopted by the Society for Endocrinology, Metabolism and Diabetes in South African in 2009.

Available at http://www.semdsa.org.za/files/Diabetes%20Guidelines%202009.pdf 

 A single page easy to follow chart and a more detailed but yet easy to follow double page chart are provided by SEMDSA to guide the diagnosis and management of diabetes mellitus.

2008: Editorial on the European Society of Hypertension/European Society of Cardiology hypertension guidelines 

Editorial on the new European Society of Hypertension and European Society of Cardiology Guidelines.

Mancia and Grassi. Ther Adv Cardiovas Dis 2008;2:5-12  

This paper highlights the new features of the 2007 European Society’s Guidelines as compared to this Society’s guidelines published in 2003.  

2008: NICE guideline on lipid modification

National Institute for Health and Clinical Excellence Guidance on Lipid Modification for the Primary and Secondary Prevention of Cardiovascular Disease.

Available at http://www.nice.org.uk/CG067

This guideline originally issued in May 2008, was revised in March 2010 to modify the recommendations regarding the choice of equation for the assessment of cardiovascular risk.   

2007: European Society of Hypertension/European Society of Cardiology hypertension guidelines 

European Society of Hypertension and European Society of Cardiology Guidelines for the Management of Arterial Hypertension.

Mancia et al. J Hypertens 2007;25:1105-1187.   

These are the most recent European Guidelines on the diagnosis and management of hypertension. These Society’s previous “guidelines” had been published in 2003. Based on new evidence a re-appraisal was conducted and published in 2009 (see above).

2006: British Hypertension Society (BHS) Guidelines Update 

Updated June 2006 in collaboration with NICE (National Institute for Health and Clinical Excellence of the United Kingdom).

Available at http://www.nice.org.uk/CG34

The major alteration in the BHS guidelines is that this Society no longer recommends beta blockers as first line therapy. This view is not completely shared by the European Society of Hypertension Task Group that in 2009 reappraised the European Society of Hypertension/European Society of Cardiology 2007 guidelines.

2006: SAHS Hypertension Guidelines Algorithm

Algorithm- SAHS final.pdf << click to download>>

In order to provide a quick clinical decision making tool for health practitioners that is based on current scientific evidence, in 2006 the SAHS developed a 9 Step educational algorithm, based on the SAHS guidelines, that fits onto a single page.

2006: SA Hypertension guidelines  

        Seedat et al. S Afr Med Journal 2006;96:337-362   

In 2006 the SAHS published a Joint National Hypertension Guideline which was a collaboration between the Department of Health and the SA Hypertension Society. This guideline was developed, not to supersede other guidelines but to provide guidelines which account for resource poor communities whilst at the same time enable best clinical practice. This guideline is currently being updated with the view towards releasing a new publication in 2012.  

2006: Recommendations for the early detection and management of chronic kidney disease. 

Produced and adopted by the South African Renal Society in March 2006.

Available at http://sa-renalsociety.org/guidelines.asp   

 This one page easy to follow chart defines chronic kidney disease; lists the risk factors for chronic kidney disease; indicates how to screen for chronic kidney disease; addresses the issue of referral of patients with renal dysfunction and provides recommendations for the preservation of renal function in patients with chronic kidney disease.

2006: NICE statin recommendation from UK. 

Available at http://www.nice.org.uk/TA094    

The National Institute for Health and Clinical Excellence (NICE) issued guidance in January 2006 to the National Health Services (NHS) in England and Wales on the use of statins for the primary prevention of cardiovascular disease (CVD) in adults and for the treatment of adults with established CVD. The guidance, which is set to benefit millions of adults in England and Wales, recommends that statins be used either where there is clinical evidence of an individual having CVD, or where the risk of an individual developing CVD within 10 years is estimated to be 20% or greater. This is the same as the SA recommendations by the SA lipid group (LASSA).

2006: NICE clinical guideline on the prevention, identification, assessment and management of overweight and obesity. 

Available at http://www.nice.org.uk/Guidance/CG43/NICEGuidance    

The National Institute for Health and Clinical Excellence (NICE) issued guidance in December 2006 to the National Health Services (NHS) in England and Wales on the prevention and clinical management of overweight and obesity. These recommendations are based upon best available evidence of effectiveness, including cost effectiveness.

2005: Obesity in South Africa: challenges for government and health professionals.

Salome Kruger et al. Public Health Nutrition 2005;8:491-500    

This manuscript reviews the data on the prevalence, causes and health consequences of obesity in South Africa. Interventions to prevent and treat obesity and its related outcomes are also proposed.

2005: Practice guidelines of the European Society of Hypertension for clinic, ambulatory and self blood pressure measurement 

Report prepared on behalf of the European Society of Hypertension Working Group on Blood Pressure Monitoring.

J Hypertens 2005, 23:697-701 .  

This manuscript is a summary of the updated recommendations on conventional, ambulatory and self blood pressure measurement published by the European Society of Hypertension Working Group on Blood Pressure Monitoring in 2003.

2005: Public health strategies for preventing and controlling overweight and obesity in school 

Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5410a1.htm     

Recommendations of the US Task Force on Community Preventive Services (Center for Disease Control) on public health strategies that may prevent and control overweight and obesity in schools and hence limit the development of hypertension later in life.

2004: High Blood Pressure in children.

National High Blood Pressure Education Program (NHBPEP) 4th Report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Region: US.

Pediatrics 2004;114:555-576   

This document is currently the only available guideline for the diagnosis and management of hypertension in children.

2003: Joint National Committee 7 National Heart, Lung and Blood Institutes hypertension guidelines. 

Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure.

Hypertension. 2003;42:1206-1252.   

Available at http://www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.pdf

These are the official and the most recent North American guidelines on hypertension and it is the 7^th time that these guidelines have been updated. The Joint National Committee 8 guidelines have been promised for 2011.

2003: Sub-Saharan Africa Hypertension guideline  

Recommendations for prevention, diagnosis and management of hypertension and cardiovascular risk factors in sub-Saharan Africa.

Lemogoum et al. J Hypertens 2003, 21:1993-2000.

In 2003, 70 prominent African and international experts on hypertension and cardiovascular disease formulated these recommendations which are based upon the 2003 WHO/ISH Statement on the Management of Hypertension; the 2002 Cardiovascular Risk Management Package in Low-and Medium-Resource Settings; the American JNC 7 guidelines; the European guidelines; and a consensus statement of the Hypertension in African-Americans Working Group of the International Society on Hypertension in Blacks.

2003: Treatment of Hypertension in Adults with Diabetes. 

American Diabetes Association, Diabetes Care 2003;26(S1):S80-83

This document describes the special approach to the treatment of hypertension in patients with diabetes mellitus. Some of the approaches outlined are contentious and are presently being debated by a number of guidelines committees.

2002: WHO CVD-Risk Management Package

Available at http://www.who.int/cardiovascular_diseases/priorities/management/package/en/

This WHO Report entitled “CVD-risk management package for low- and medium resource settings”, published in 2002 outlines the problems and potential solutions of risk assessment in low and medium resource settings.