The Evolution of Hypertension Guidelines Over the Last 20+ Years: A Comprehensive Review

• Authors: Endurance O Evbayekha, St. Luke's Hospital, Chesterfield; Okelue E Okobi, Arizona State University; Tobechukwu Okobi, BronxCare Health System; Emeka C Ibeson, Maimonides Medical Center; Jane N Nwafor, University of DC, Silver Spring; Oyintoun-emi Ozobokeme, Central Michigan University; Adedoyin Olawoye, Maimonides Medical Center; Ihuoma A Ngoladi, Family Medicine, Private Practice, Calgary; Maureen G Boms, University of Alabama at Birmingham; Faridah A Habib, Alberta International Medical Graduates Association (AIMGA); Babatunde O Oyelade, Emory University; Caroline C Okoroafor, University of Calabar; Vivian N Chukwuma, University of Illinois at Chicago; Kesena B Alex, University of London; Evidence E Ohikhuai, Jackson State University
• Journal Title: Cureus
• Volume: Volume 14, Number 11
• Publisher: Cureus, Inc. | 2022-11-13
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.7759/cureus.31437
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Public Health
• Keywords: heart health; cardiovascular disease; hypertensive heart disease; review; guidelines; hypertension

Abstract

Hypertension is the most common modifiable risk factor for cardiovascular and cerebrovascular diseases. In the last two decades, the guidelines have evolved tremendously from areas with no recommendations for screening or treatment to targeted recommendations for some at-risk groups. We sought to go through the literature that provided guidelines for the management of hypertension at any point in time over the last 22 years from 2000 to 2022. We searched four databases: PubMed, Embase, Google Scholar, and Cochrane, using specified search terms. The keywords used were "hypertension" and "guidelines." We combined them using the Boolean operators (AND, OR) and searched for articles. A total of 2461 publications were initially identified; 348 publications were excluded after screening for full-text availability. The full-text articles were further filtered based on title and abstract screening. Following this, a total of 1443 articles were excluded. The remaining 670 full-text articles were assessed for eligibility. Of the 670 full-text articles, 480 were excluded based on exclusion criteria, and following the full-text article screening, 190 articles met the final inclusion criteria. Most of these guideline evolutions concerned establishing and adjusting thresholds for the subgroups of the elderly population and patients with diabetic kidney disease, chronic kidney disease, and stroke. Furthermore, the medications of choice are now guided by the stage of disease, presence or absence of comorbidities, and other relevant information, as opposed to ethnicity, which was previously a heavy yardstick for medication choice.