The Impact of the 2017 American College of Cardiology/American Heart Association and the 2018 European Society of Cardiology/European Society of Hypertension Guidelines on the Asian Population: Is it Time for Our Own Asian Hypertension Guidelines?

Abstract

Hypertension (HTN) remains to be the single most important risk factor for the development of cardiovascular disease worldwide. Moreover, the global burden of disease is expected to rise even more in the coming years due to the obesity epidemic and the aging population. However, control rates of high blood pressure (BP) remain low. The American College of Cardiology/American Heart Association 2017 Guidelines and the European Society of Cardiology/European Society of HTN 2018 Guidelines have different thresholds and targets, with the US guideline “redefining” HTN to a new lower level, while the European guideline remains unchanged from its previous levels. There is now emphasis on proper BP measurement for accurate initial diagnosis, and the use of home and ambulatory BP monitors is encouraged to ensure strict 24-h (morning and evening) BP control. Lifestyle modifications are encouraged, especially in the elderly who are more responsive to salt restriction. Asian characteristics of HTN warrant further study. Enhanced salt sensitivity, high dietary salt intake, aging population, and obesity are just some of the different characteristics of Asian HTN. More importantly, stroke is a more common consequence of uncontrolled HTN in Asia (compared to coronary artery disease), with hemorrhagic stroke having a relatively higher prevalence. Hence, lower BP targets are needed since BP levels correlate more linearly with stroke. China, Japan, Taiwan, and Korea have come up with published guidelines, highlighting some key points and difference with the US and European guidelines. The Philippine Society of HTN also previously came out with the “140/90 Report,” locally attuning foreign guidelines. Several years back, there has been a call for the development of our own Asian HTN guidelines. With newer findings on the benefits of lower BP targets/goals and its possible benefits to the Asian population and more findings on the different Asian characteristics of HTN, it might be the best time now to heed that call.