Sample reviewed Jennings, G. L., & Touyz, R. M. (2013, August 19). Hypertension Guidelines: More Challenges Highligted by Europe.

Retrieved October 10, 2013, from ahajournals: http:hyper.ahajournals.org/content/62/4/660 Hypertension is referred to the risk of high blood pressure, in a condition which the arteries have persistently elevated the blood pressure. Thus, each time the human heart beats; it pumps the blood to the whole body through the arteries. The blood pressure is the force of blood pushing up against the blood vessel walls. Thus, the higher the pressure the harder the heart has to pump. Researchers from UC Davis reported in the Journal of the American Academy of Neurology that high blood pressure during middle age may raise the risk of cognitive decline later in life. This hypertension leads to damaged organs, as well as several illnesses, such as kidney failure, heart failure, stroke and even heart attack. Several studies has been done to provide the good guidelines in preventing and also in treating the hypertension but then the challenges are always there developing time to time. According to a study, Hypertension Guidelines: More Challenges Highlighted by Europe written by Garry L.R. Jennings and Rhian M. Touyz, retrieved from http://hyper.ahajournals.org/content/62/4/660 on 10th October 2013, also discusses about the guidelines on the hypertension and the challenges of it. The author indicate in the journal about the new set of guidelines of the cause for the reflection where both the changing scene in hypertension and on the application of guidelines to improve outcomes in people with hypertension in their community (page 660). The authors find out that the challenges of the hypertension can be helped by the findings of the new BP measurement which helps in comprising the general understanding of the hypertension.

In the article, the authors have basically written a pocket guideline in helping to understand and measure the better about the hypertension and the treatments of it. The authors also mentioned the reason of why there are different guidelines because it draws different conclusions. The first reason is because there are influences in the guideline development, thus the authors mentioned that there will be a problem if there should be a guideline that fits the whole Europe on this hypertension problem. This is because it contains different nominees, and members of the panels were allocated in their own different reasons. Therefore the authors have suggested in order by having a useful and a progressive guideline, there should be a local flavour and the more general guidelines become, the more adaptable, flexible, and culturally specific they must be in their implementation (page 660). Means there should be a flexible and an adaptive guideline to help them understand about the hypertension. The article mentions that the second reason to have a different guideline is because the disease burden varies. This is because the authors mentioned that the relationship between the diseases varied from population to population. The authors discussed that the main strength of the hypertension is related to the stroke and the coronary artery diseases. the pattern of comorbidities is another variable (page 660), whereby the authors mentioned that the risk of having the disease are pertinent to the diagnosis and management of the

cardiovascular risk (page 660). Using the Systematic Coronary risk model, the authors mentioned that in order to estimate the risk of the death from the cardiovascular disease which were based on a ten years practice, the risk was taken based on the age, sex, smoking habits, cholesterol, and systolic blood pressure (BP). (page 660). In addition to that, the authors also explain about the drug responses that vary according to the people and their ages. The drug therapies that varies to their ages shows that not the same therapies can be used to all people, response to drug therapies epitomized by

the benefits of thiazide diuretics and calcium channel blockers in lowering BP in blacks and perhaps in older people of all races, whereas blockers of the renin angiotensin system and adrenoceptor receptor blockers are just as effective in some other populations (page 660). The urbanization is also another factor that leads to the different guideline as well as the different resources availability. This is because the different development in the urbanization leads to different pattern on the Blood pressure that leads to the hypertension among the communities. This is because in developed countries, hypertension is more common in rural populations than in urban. This pattern is reversed in developing, lower-, and middle-income countries where the first impact of rising rates of hypertension is seen in urban communities. (page 660). The different resources vary for different regions because the cost is different at different regions. The drug cost and the availability, and the feasibility of recommendations made for the diagnostics (page 661) varies for different people and for different countries. The authors also managed to discuss about the vested interest and the lifestyle of people that affects the hypertension guideline. The vested interest can be due to the variety of industry pressure or the government-controlled health system in trying to moderate its costs, or even clinicians themselves wanting validating of their wishes to access new technology and therapies (page 661). The authors explain that the reason can be due to the influences in the usage of generic over branded drug preparations. The lifestyle, explained by the authors, refers to the lifestyle they lead in relation to the therapies that they gain. As for example, the authors mentioned that the recommendation of the alcohol usage is not proper to the communities that do not take alcohol. As for the usage of salt and so on, it also do differs because the physical activity varies considerably between communities and the nutritional factors (page 661). In addition to that, the authors also discussed that the decision support system needs to be improved as some systems still using the old filing system and not being

updated with the new system. Other than that, the old system causing the files of the patients being kept longer and decision making system is becoming poor in management. The guidelines according to the authors have suggested something new which is the BP measurement. This BP measurement indicates the better support of the BP measurements in a major relevance especially in including the home BP monitoring (page 661). Thus, the out-of-office BP measurement is important in order to diagnosis hypertension and as the out-of-office BP measurements play an important role in hypertension management. (page 661). The authors also have clearly diagnosis the recommendations that are common to all contemporary hypertension guidelines. The authors discussed that the blood pressure as a continuous variable in a practical purposes which can be broken down into several grades. He also discussed that the hypertension is bad for people (page 662) and also to measure blood pressure carefully (page 662). In addition to that, the authors also clearly discussed that the hypertension is a risky disease for those who have additional diseases such as the multiple cardiovascular risk factors, rennin diseases and so on. The usage of drugs and the lifestyles of people have also been clearly discussed in relationship to the BP measurement and to the hypertension disease. In the same article, the authors revealed that the hypertension therapies and the treatments varies according to different guidelines whereby the basic guidelines said that the more measurements that are taken, the better the precision in estimating the mean (page 662) however, these guidelines are at odds with the British guideline. This is because the guideline recommends ambulatory BP measurement (page 662) which is based on the study performed by the National Institute of Clinical Excellence. The authors also mentioned a clear discussion on the attention in the new guidelines and shifted them to variations in BP as there are importance data on the BP of particular times of the day ( page 662 ). The proof was used as the authors discussed about the white coat and the masked hypertension as

there were associated with more prognosis and organ damaged ( page 662 ) because there were no trials or prevention in diagnosing the effects of it. Thus, the authors also furthered his discussion in explaining about the factors influencing prognosis and work up. According to the authors, the ESH/ESC guidelines list some 30 other different factors other than BP office that influence prognosis and can be used to help satisfy risk. (page 662). The authors also explained that the factors are listed under multiple headings of risk factors such as asymptomatic organ damage, diabetes mellitus, and established cardiovascular or renal diseases. (page 662). The authors findings and explanation suggest that the clinicians needed to know better about the risk factors and the effects of the any implementations that are being done. The significant result to what has been done has to co-relate with the risks that they might face later on. The authors mentioned that the clinicians may need more guidance on why they should use absolute or relative risk and this is because they might meet with varieties of consequences such as organ damages or others. In order to help to solve the poor resource service and to cut off the cost that are being part of the reasons of the variations in dealing with the hypertension, the most suitable work up is also being discussed here by the authors. The authors discussed about the what work up is the most cost-effective? (page 662). Thus, the arguments were mainly based on the necessary and the unnecessary treatments that are being done and also the additional cost treatments that are being lead to help in restraining the problem. Thus, the authors actually strained that a cost-effective work up needs to have feasibility, availability, and cost, but other tests that are no more freely available get more favourable treatment. (page 663). The guidelines actually helps in identifying the actual most risk that they could face and also based on the signs that they have at what level of hypertension they are in helping them to get the most reasonable treatments.

The treatments and the targets were discussed in order to understand about how far the new guidelines measure the appraisal of the BP measurement. In the article, the authors discussed that at many point these targets were not met in randomized controlled trials and the evidence supporting them is scant or absent, especially in people with diabetes mellitus or renal disease. (page 663). The authors seriously made a point that the new implementations and the guidelines are not really new as the lifestyle measures in every recommended medicines taken. The fact that the salt restriction, alcohol moderation, high consumption of vegetables, fruits. Low fat intake, weight reduction, physical exercise, and cessation of cigarette (page 663) are taken into consideration for every intake of the treatment taken. The new guidelines are important in order to measure the amount for the amount of medicines taken. As for the drugs, the amount recommended by the ESH/ESC is still the same and the types of the drugs are also unchanged; diuretics, b-adrenoceptor blockers, calcium channel blockers, angiotensin-converting, enzyme inhibitors,and angiotensin receptor blockers. (page 663). However, different guidelines measure different amount and types and the guidelines seems to be different for each therapy accordingly. In addition to that, the authors also explained about the resistant hypertension and discussed about it. In between the 2007 till 2013, there was a great change in the field of resistant hypertension whereby a lot of studies and treatments were done in this field. According to the authors, there are recommendations in line with the needs of the resistant hypertension favours whereby the resistant hypertensive patients should withdraw drugs that are shown not to lower BP. This is because the need of it is not there unless it is optimal drug therapy which is ineffective. The authors also suggest that there should be an experienced team in doing this procedure and the follow-ups. Despite of that, the authors also mentioned that there is a shortcoming especially when the clinician is faced with the challenges of managing a patient with resistant hypertension. (page 663 -664). In addition,

there were also unsure about whether how the a treatment should be withdrawn or if there should be any alternate drugs that can be used to replace the one in used now. As an overall, the authors conclude that the most affected people will always be the patient but the clinicians will also be affected. This is because the clinicians will definitely be stress as there are too many guidelines added with a large numbers of patients to be handled. However, the new guidelines will definitely be helpful because the BP measurement id more marginal and it helps in understanding better about the proper treatments and the therapies that needed to be done. The old guidelines are more scattered and messy as it does not take into account the other things such as the usage of drug, the lifestyle, and the additional diseases and so on. However, the new guidelines are narrower, thus it is better in usage. The authors also concluded that another reason of why there are varieties in the guidelines recommendation is because there is lack of evidence to understand the absolute risk in order to provide the patients with the treatments. This is supported with the fact that the data that lie behind them are based on short-term observations, ad waiting until absolute risk is high resulted into organ damage and irreversible changes in the circulation. (page 664). The authors also made a stand that his findings on this guideline are inevitably flawed (page 664). The fact that the evidences and judgements are based on clear examples and also are complete based on the importance of all the data collected. The overall finding about the hypertension gives me a clear understanding on how complicated the hypertension is as all the patients could not be the same and they need different treatments and also therapies. However, i found that the article still has a lot of flaws as there are no certain margins in knowing the exact treatments about what should be done. It is like hanging in the cliff as there are no exact conclusion in what to do next. In addition to that, I find that the authors fail to provide a proper graph in showing the figures of the comparison between the old and the new guidelines. However, I will not deny that i find

it fascinating to understand that the new guidelines actually provide so much information that one needs to know before proceeding to the treatments and the therapies. It had never crosses my mind that our daily lifestyle can give such a big impact on the treatments we are taking. Thus, that piece of information can alert many people especially clinicians in order to pursue their jobs. Thus, this article is more compliant to the clinicians as it explains more on the new BP measurement that could be helpful for them in giving appropriate treatments. However, the information in the article will definitely be useful to public as we can get to know more about what to do if we have hypertension and things to be alert of. In addition to that, the BP measurement also indicates about the daily consumption and the night treatment especially about the out-of-office treatments. As a conclusion, each one of us should be aware of this hypertension problem that we are facing in our society now and need to know about the treatments and the therapies that we are going through in order to avoid any other injuries such as the organ damages, or other internal injuries. Thus, Jennings and Touyz in their article ; Hypertension Guidelines: More Challenges Highlighted by Europe have clearly discussed about the new guidelines that will not only be useful for the clinicians and the patients but also for the public.