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

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.

Keywords: Antihypertensive agents; Hypertension; Practice guideline; Risk factors.

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.