7^th Brazilian Guideline of Arterial Hypertension: Chapter 5 – Therapeutic Decision and Targets

Introduction

The therapeutic management of elevated BP includes non-pharmacological measures and the use of antihypertensive drugs to reduce BP, protect target organs and prevent CV and renal outcomes.^– Non-pharmacological measures have proven efficient to reduce BP, although limited by medium- and long-term lack of adherence to treatment. A systematic review of studies with a minimum duration of 12-24 months, combining dietary interventions and moderate-to-high-intensity physical activity in patients using or not medications, has revealed a reduction in SBP and DBP for < 12 months of -4.47 (-7.91 to -1.04) mm Hg and -1.10 (-2.39 to 0.19) mm Hg, respectively. For 12 to 24 months, the reductions were -2.29 (-3.81 to -0.76) mm Hg and -1.00 (-3.22 to 1.22) mm Hg in SBP and DBP, respectively. The direct impact of those measures on the risk of CV outcomes is uncertain, the studies are small and short, and the effects on other RF could contribute to CV protection.

On the other hand, results of randomized placebo-controlled clinical trials on the use of antihypertensive drugs for hypertensive individuals have clearly shown a significant reduction in CV mortality, stroke, MI and HF. It is worth noting that most of those studies have assessed individuals aged ≥ 55 years, at high CV risk and for a follow-up period of 3 to 6 years, hindering, thus, the extrapolation of those benefits for long-term treatment and patients with other characteristics.

[…]