Intensive BP control recommended for Asian patients at high CV risk
Intensive blood pressure (BP) control is recommended for Asian patients with hypertension and increased cardiovascular (CV) risk, such as those with comorbid type 2 diabetes mellitus (T2DM), chronic kidney disease (CKD) or atrial fibrillation (AF), according to a recently published consensus document.
The consensus document on improving hypertension management in Asian patients was developed by experts from China, Japan, South Korea and Taiwan in view of the significant ethnic differences in determinants of hypertension and hypertension-related demographics of CV disease (CVD) between Asian and Western populations. [Hypertension 2018;71:375-382]
“Stroke, especially haemorrhagic stroke, and nonischaemic heart failure are common outcomes of hypertension-related CVD in Asia. The association between BP and CVD is stronger in Asia than in the West. Higher salt sensitivity, even with mild obesity and higher salt intake, is an Asian characteristic of hypertension,” the experts noted.
For Asian hypertensive patients with T2DM, the experts suggested a BP goal of <130/80 mm Hg. For those with CKD, intensive BP control is recommended, along with more intensive out-of-office BP monitoring and comprehensive CV evaluation. In those with AF receiving anticoagulant therapy, a target systolic BP of <130 mm Hg can be considered.
For elderly patients, the experts recommended a BP target of <140/90 mm Hg, to be achieved with calcium channel blockers (CCBs), renin-angiotensin system (RAS) blockers and diuretics.
Highlighting the importance of strict 24-hour BP control in Asian patients, the experts recommended a home BP-guided approach as the first practical step. “The use of a long-acting and potent CCB and RAS inhibitor, with or without a diuretic, is preferable,” they noted.
In addition, out-of-office BP measurement is recommended to detect white-coat hypertension, while accurate detection and management of masked or masked uncontrolled hypertension is also important. “The initial focus should be on morning BP, then nocturnal BP, in Asian populations,” the experts advised.
“Morning BP surge confers CV risk independent of 24-hour ambulatory BP. Morning BP control can and should be improved with the use of long-acting antihypertensives in appropriate, often full, dosages and in proper combinations,” they added.