2015 Guidelines of the Taiwan Society of Cardiology and the Taiwan Hypertension Society for the Management of Hypertension

Chern En Chiang, Tzung Dau Wang, Kwo Chang Ueng, Tsung Hsien Lin, Hung I. Yeh, Chung Yin Chen, Yih Jer Wu, Wei Chuan Tsai, Ting Hsing Chao, Chen Huan Chen, Pao Hsien Chu, Chia Lun Chao, Ping Yen Liu, Shih Hsien Sung, Hao Min Cheng, Kang Ling Wang, Yi Heng Li, Fu Tien Chiang, Jyh Hong Chen, Wen Jone ChenSan Jou Yeh, Shing Jong Lin

Research output: Contribution to journalArticle

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Abstract

It has been almost 5 years since the publication of the 2010 hypertension guidelines of the Taiwan Society of Cardiology (TSOC). There is new evidence regarding the management of hypertension, including randomized controlled trials, non-randomized trials, post-hoc analyses, subgroup analyses, retrospective studies, cohort studies, and registries. More recently, the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) published joint hypertension guidelines in 2013. The panel members who were appointed to the Eighth Joint National Committee (JNC) also published the 2014 JNC report. Blood pressure (BP) targets have been changed; in particular, such targets have been loosened in high risk patients. The Executive Board members of TSOC and the Taiwan Hypertension Society (THS) aimed to review updated information about the management of hypertension to publish an updated hypertension guideline in Taiwan.We recognized that hypertension is the most important risk factor for global disease burden. Management of hypertension is especially important in Asia where the prevalence rate grows faster than other parts of the world. In most countries in East Asia, stroke surpassed coronary heart disease (CHD) in causing premature death. A diagnostic algorithm was proposed, emphasizing the importance of home BP monitoring and ambulatory BP monitoring for better detection of night time hypertension, early morning hypertension, white-coat hypertension, and masked hypertension. We disagreed with the ESH/ESH joint hypertension guidelines suggestion to loosen BP targets to <140/90mmHg for all patients. We strongly disagree with the suggestion by the 2014 JNC report to raise the BP target to <150/90mmHg for patients between 60-80 years of age. For patients with diabetes, CHD, chronic kidney disease who have proteinuria, and those who arereceiving antithrombotic therapy for stroke prevention, we propose BP targets of <130/80mmHg in our guidelines. BP targets are<140/90mmHg for all other patient groups, except for patients ≥80 years of age in whom a BP target of <150/90mmHg would be optimal.For the management of hypertension, we proposed a treatment algorithm, starting with life style modification (LSM) including S-ABCDE (. Sodium restriction, Alcohol limitation, Body weight reduction, Cigarette smoke cessation, Diet adaptation, and Exercise adoption). We emphasized a low-salt strategy instead of a no-salt strategy, and that excessively aggressive sodium restriction to <2.0gram/day may be harmful. When drug therapy is considered, a strategy called ". PROCEED" was suggested (. Previous experience, Risk factors, Organ damage, Contraindications or unfavorable conditions, Expert's or doctor's judgment, Expenses or cost, and Delivery and compliance issue). To predict drug effects in lowering BP, we proposed the ". Rule of 10" and ". Rule of 5". With a standard dose of any one of the 5 major classes of anti-hypertensive agents, one can anticipate approximately a 10-mmHg decrease in systolic BP (SBP) (Rule of 10) and a 5-mmHg decrease in diastolic BP (DBP) (Rule of 5). When doses of the same drug are doubled, there is only a 2-mmHg incremental decrease in SBP and a 1-mmHg incremental decrease in DBP. Preferably, when 2 drugs with different mechanisms are to be taken together, the decrease in BP is the sum of the decrease of the individual agents (approximately 20mmHg in SBP and 10mmHg in DBP). Early combination therapy, especially single-pill combination (SPC), is recommended.When patient's initial treatment cannot get BP to targeted goals, we have proposed an adjustment algorithm, ". AT GOALs" (. Adherence, Timing of administration, Greater doses, Other classes of drugs, Alternative combination or SPC, and LSM+. Laboratory tests). Treatment of hypertension in special conditions, including treatment of resistant hypertension, hypertension in women, and perioperative management of hypertension, were also mentioned.The TSOC/THS hypertension guidelines provide the most updated information available in the management of hypertension. The guidelines are not mandatory, and members of the task force fully realize that treatment of hypertension should be individualized to address each patient's circumstances. Ultimately, the decision of the physician decision remains of the utmost importance in hypertension management.

Original languageEnglish
Pages (from-to)1-47
Number of pages47
JournalJournal of the Chinese Medical Association
Volume78
Issue number1
DOIs
Publication statusPublished - 2015 Jan 1

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Cardiology
Taiwan
Guidelines
Hypertension
Blood Pressure
Ambulatory Blood Pressure Monitoring
Coronary Disease
Life Style
Masked Hypertension
Therapeutics
Salts
Joints
Sodium
Stroke
White Coat Hypertension
Pharmaceutical Preparations
Social Adjustment
Information Management
Premature Mortality
Far East

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Chiang, Chern En ; Wang, Tzung Dau ; Ueng, Kwo Chang ; Lin, Tsung Hsien ; Yeh, Hung I. ; Chen, Chung Yin ; Wu, Yih Jer ; Tsai, Wei Chuan ; Chao, Ting Hsing ; Chen, Chen Huan ; Chu, Pao Hsien ; Chao, Chia Lun ; Liu, Ping Yen ; Sung, Shih Hsien ; Cheng, Hao Min ; Wang, Kang Ling ; Li, Yi Heng ; Chiang, Fu Tien ; Chen, Jyh Hong ; Chen, Wen Jone ; Yeh, San Jou ; Lin, Shing Jong. / 2015 Guidelines of the Taiwan Society of Cardiology and the Taiwan Hypertension Society for the Management of Hypertension. In: Journal of the Chinese Medical Association. 2015 ; Vol. 78, No. 1. pp. 1-47.
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abstract = "It has been almost 5 years since the publication of the 2010 hypertension guidelines of the Taiwan Society of Cardiology (TSOC). There is new evidence regarding the management of hypertension, including randomized controlled trials, non-randomized trials, post-hoc analyses, subgroup analyses, retrospective studies, cohort studies, and registries. More recently, the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) published joint hypertension guidelines in 2013. The panel members who were appointed to the Eighth Joint National Committee (JNC) also published the 2014 JNC report. Blood pressure (BP) targets have been changed; in particular, such targets have been loosened in high risk patients. The Executive Board members of TSOC and the Taiwan Hypertension Society (THS) aimed to review updated information about the management of hypertension to publish an updated hypertension guideline in Taiwan.We recognized that hypertension is the most important risk factor for global disease burden. Management of hypertension is especially important in Asia where the prevalence rate grows faster than other parts of the world. In most countries in East Asia, stroke surpassed coronary heart disease (CHD) in causing premature death. A diagnostic algorithm was proposed, emphasizing the importance of home BP monitoring and ambulatory BP monitoring for better detection of night time hypertension, early morning hypertension, white-coat hypertension, and masked hypertension. We disagreed with the ESH/ESH joint hypertension guidelines suggestion to loosen BP targets to <140/90mmHg for all patients. We strongly disagree with the suggestion by the 2014 JNC report to raise the BP target to <150/90mmHg for patients between 60-80 years of age. For patients with diabetes, CHD, chronic kidney disease who have proteinuria, and those who arereceiving antithrombotic therapy for stroke prevention, we propose BP targets of <130/80mmHg in our guidelines. BP targets are<140/90mmHg for all other patient groups, except for patients ≥80 years of age in whom a BP target of <150/90mmHg would be optimal.For the management of hypertension, we proposed a treatment algorithm, starting with life style modification (LSM) including S-ABCDE (. Sodium restriction, Alcohol limitation, Body weight reduction, Cigarette smoke cessation, Diet adaptation, and Exercise adoption). We emphasized a low-salt strategy instead of a no-salt strategy, and that excessively aggressive sodium restriction to <2.0gram/day may be harmful. When drug therapy is considered, a strategy called {"}. PROCEED{"} was suggested (. Previous experience, Risk factors, Organ damage, Contraindications or unfavorable conditions, Expert's or doctor's judgment, Expenses or cost, and Delivery and compliance issue). To predict drug effects in lowering BP, we proposed the {"}. Rule of 10{"} and {"}. Rule of 5{"}. With a standard dose of any one of the 5 major classes of anti-hypertensive agents, one can anticipate approximately a 10-mmHg decrease in systolic BP (SBP) (Rule of 10) and a 5-mmHg decrease in diastolic BP (DBP) (Rule of 5). When doses of the same drug are doubled, there is only a 2-mmHg incremental decrease in SBP and a 1-mmHg incremental decrease in DBP. Preferably, when 2 drugs with different mechanisms are to be taken together, the decrease in BP is the sum of the decrease of the individual agents (approximately 20mmHg in SBP and 10mmHg in DBP). Early combination therapy, especially single-pill combination (SPC), is recommended.When patient's initial treatment cannot get BP to targeted goals, we have proposed an adjustment algorithm, {"}. AT GOALs{"} (. Adherence, Timing of administration, Greater doses, Other classes of drugs, Alternative combination or SPC, and LSM+. Laboratory tests). Treatment of hypertension in special conditions, including treatment of resistant hypertension, hypertension in women, and perioperative management of hypertension, were also mentioned.The TSOC/THS hypertension guidelines provide the most updated information available in the management of hypertension. The guidelines are not mandatory, and members of the task force fully realize that treatment of hypertension should be individualized to address each patient's circumstances. Ultimately, the decision of the physician decision remains of the utmost importance in hypertension management.",
author = "Chiang, {Chern En} and Wang, {Tzung Dau} and Ueng, {Kwo Chang} and Lin, {Tsung Hsien} and Yeh, {Hung I.} and Chen, {Chung Yin} and Wu, {Yih Jer} and Tsai, {Wei Chuan} and Chao, {Ting Hsing} and Chen, {Chen Huan} and Chu, {Pao Hsien} and Chao, {Chia Lun} and Liu, {Ping Yen} and Sung, {Shih Hsien} and Cheng, {Hao Min} and Wang, {Kang Ling} and Li, {Yi Heng} and Chiang, {Fu Tien} and Chen, {Jyh Hong} and Chen, {Wen Jone} and Yeh, {San Jou} and Lin, {Shing Jong}",
year = "2015",
month = "1",
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doi = "10.1016/j.jcma.2014.11.005",
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Chiang, CE, Wang, TD, Ueng, KC, Lin, TH, Yeh, HI, Chen, CY, Wu, YJ, Tsai, WC, Chao, TH, Chen, CH, Chu, PH, Chao, CL, Liu, PY, Sung, SH, Cheng, HM, Wang, KL, Li, YH, Chiang, FT, Chen, JH, Chen, WJ, Yeh, SJ & Lin, SJ 2015, '2015 Guidelines of the Taiwan Society of Cardiology and the Taiwan Hypertension Society for the Management of Hypertension', Journal of the Chinese Medical Association, vol. 78, no. 1, pp. 1-47. https://doi.org/10.1016/j.jcma.2014.11.005

2015 Guidelines of the Taiwan Society of Cardiology and the Taiwan Hypertension Society for the Management of Hypertension. / Chiang, Chern En; Wang, Tzung Dau; Ueng, Kwo Chang; Lin, Tsung Hsien; Yeh, Hung I.; Chen, Chung Yin; Wu, Yih Jer; Tsai, Wei Chuan; Chao, Ting Hsing; Chen, Chen Huan; Chu, Pao Hsien; Chao, Chia Lun; Liu, Ping Yen; Sung, Shih Hsien; Cheng, Hao Min; Wang, Kang Ling; Li, Yi Heng; Chiang, Fu Tien; Chen, Jyh Hong; Chen, Wen Jone; Yeh, San Jou; Lin, Shing Jong.

In: Journal of the Chinese Medical Association, Vol. 78, No. 1, 01.01.2015, p. 1-47.

Research output: Contribution to journalArticle

TY - JOUR

T1 - 2015 Guidelines of the Taiwan Society of Cardiology and the Taiwan Hypertension Society for the Management of Hypertension

AU - Chiang, Chern En

AU - Wang, Tzung Dau

AU - Ueng, Kwo Chang

AU - Lin, Tsung Hsien

AU - Yeh, Hung I.

AU - Chen, Chung Yin

AU - Wu, Yih Jer

AU - Tsai, Wei Chuan

AU - Chao, Ting Hsing

AU - Chen, Chen Huan

AU - Chu, Pao Hsien

AU - Chao, Chia Lun

AU - Liu, Ping Yen

AU - Sung, Shih Hsien

AU - Cheng, Hao Min

AU - Wang, Kang Ling

AU - Li, Yi Heng

AU - Chiang, Fu Tien

AU - Chen, Jyh Hong

AU - Chen, Wen Jone

AU - Yeh, San Jou

AU - Lin, Shing Jong

PY - 2015/1/1

Y1 - 2015/1/1

N2 - It has been almost 5 years since the publication of the 2010 hypertension guidelines of the Taiwan Society of Cardiology (TSOC). There is new evidence regarding the management of hypertension, including randomized controlled trials, non-randomized trials, post-hoc analyses, subgroup analyses, retrospective studies, cohort studies, and registries. More recently, the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) published joint hypertension guidelines in 2013. The panel members who were appointed to the Eighth Joint National Committee (JNC) also published the 2014 JNC report. Blood pressure (BP) targets have been changed; in particular, such targets have been loosened in high risk patients. The Executive Board members of TSOC and the Taiwan Hypertension Society (THS) aimed to review updated information about the management of hypertension to publish an updated hypertension guideline in Taiwan.We recognized that hypertension is the most important risk factor for global disease burden. Management of hypertension is especially important in Asia where the prevalence rate grows faster than other parts of the world. In most countries in East Asia, stroke surpassed coronary heart disease (CHD) in causing premature death. A diagnostic algorithm was proposed, emphasizing the importance of home BP monitoring and ambulatory BP monitoring for better detection of night time hypertension, early morning hypertension, white-coat hypertension, and masked hypertension. We disagreed with the ESH/ESH joint hypertension guidelines suggestion to loosen BP targets to <140/90mmHg for all patients. We strongly disagree with the suggestion by the 2014 JNC report to raise the BP target to <150/90mmHg for patients between 60-80 years of age. For patients with diabetes, CHD, chronic kidney disease who have proteinuria, and those who arereceiving antithrombotic therapy for stroke prevention, we propose BP targets of <130/80mmHg in our guidelines. BP targets are<140/90mmHg for all other patient groups, except for patients ≥80 years of age in whom a BP target of <150/90mmHg would be optimal.For the management of hypertension, we proposed a treatment algorithm, starting with life style modification (LSM) including S-ABCDE (. Sodium restriction, Alcohol limitation, Body weight reduction, Cigarette smoke cessation, Diet adaptation, and Exercise adoption). We emphasized a low-salt strategy instead of a no-salt strategy, and that excessively aggressive sodium restriction to <2.0gram/day may be harmful. When drug therapy is considered, a strategy called ". PROCEED" was suggested (. Previous experience, Risk factors, Organ damage, Contraindications or unfavorable conditions, Expert's or doctor's judgment, Expenses or cost, and Delivery and compliance issue). To predict drug effects in lowering BP, we proposed the ". Rule of 10" and ". Rule of 5". With a standard dose of any one of the 5 major classes of anti-hypertensive agents, one can anticipate approximately a 10-mmHg decrease in systolic BP (SBP) (Rule of 10) and a 5-mmHg decrease in diastolic BP (DBP) (Rule of 5). When doses of the same drug are doubled, there is only a 2-mmHg incremental decrease in SBP and a 1-mmHg incremental decrease in DBP. Preferably, when 2 drugs with different mechanisms are to be taken together, the decrease in BP is the sum of the decrease of the individual agents (approximately 20mmHg in SBP and 10mmHg in DBP). Early combination therapy, especially single-pill combination (SPC), is recommended.When patient's initial treatment cannot get BP to targeted goals, we have proposed an adjustment algorithm, ". AT GOALs" (. Adherence, Timing of administration, Greater doses, Other classes of drugs, Alternative combination or SPC, and LSM+. Laboratory tests). Treatment of hypertension in special conditions, including treatment of resistant hypertension, hypertension in women, and perioperative management of hypertension, were also mentioned.The TSOC/THS hypertension guidelines provide the most updated information available in the management of hypertension. The guidelines are not mandatory, and members of the task force fully realize that treatment of hypertension should be individualized to address each patient's circumstances. Ultimately, the decision of the physician decision remains of the utmost importance in hypertension management.

AB - It has been almost 5 years since the publication of the 2010 hypertension guidelines of the Taiwan Society of Cardiology (TSOC). There is new evidence regarding the management of hypertension, including randomized controlled trials, non-randomized trials, post-hoc analyses, subgroup analyses, retrospective studies, cohort studies, and registries. More recently, the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) published joint hypertension guidelines in 2013. The panel members who were appointed to the Eighth Joint National Committee (JNC) also published the 2014 JNC report. Blood pressure (BP) targets have been changed; in particular, such targets have been loosened in high risk patients. The Executive Board members of TSOC and the Taiwan Hypertension Society (THS) aimed to review updated information about the management of hypertension to publish an updated hypertension guideline in Taiwan.We recognized that hypertension is the most important risk factor for global disease burden. Management of hypertension is especially important in Asia where the prevalence rate grows faster than other parts of the world. In most countries in East Asia, stroke surpassed coronary heart disease (CHD) in causing premature death. A diagnostic algorithm was proposed, emphasizing the importance of home BP monitoring and ambulatory BP monitoring for better detection of night time hypertension, early morning hypertension, white-coat hypertension, and masked hypertension. We disagreed with the ESH/ESH joint hypertension guidelines suggestion to loosen BP targets to <140/90mmHg for all patients. We strongly disagree with the suggestion by the 2014 JNC report to raise the BP target to <150/90mmHg for patients between 60-80 years of age. For patients with diabetes, CHD, chronic kidney disease who have proteinuria, and those who arereceiving antithrombotic therapy for stroke prevention, we propose BP targets of <130/80mmHg in our guidelines. BP targets are<140/90mmHg for all other patient groups, except for patients ≥80 years of age in whom a BP target of <150/90mmHg would be optimal.For the management of hypertension, we proposed a treatment algorithm, starting with life style modification (LSM) including S-ABCDE (. Sodium restriction, Alcohol limitation, Body weight reduction, Cigarette smoke cessation, Diet adaptation, and Exercise adoption). We emphasized a low-salt strategy instead of a no-salt strategy, and that excessively aggressive sodium restriction to <2.0gram/day may be harmful. When drug therapy is considered, a strategy called ". PROCEED" was suggested (. Previous experience, Risk factors, Organ damage, Contraindications or unfavorable conditions, Expert's or doctor's judgment, Expenses or cost, and Delivery and compliance issue). To predict drug effects in lowering BP, we proposed the ". Rule of 10" and ". Rule of 5". With a standard dose of any one of the 5 major classes of anti-hypertensive agents, one can anticipate approximately a 10-mmHg decrease in systolic BP (SBP) (Rule of 10) and a 5-mmHg decrease in diastolic BP (DBP) (Rule of 5). When doses of the same drug are doubled, there is only a 2-mmHg incremental decrease in SBP and a 1-mmHg incremental decrease in DBP. Preferably, when 2 drugs with different mechanisms are to be taken together, the decrease in BP is the sum of the decrease of the individual agents (approximately 20mmHg in SBP and 10mmHg in DBP). Early combination therapy, especially single-pill combination (SPC), is recommended.When patient's initial treatment cannot get BP to targeted goals, we have proposed an adjustment algorithm, ". AT GOALs" (. Adherence, Timing of administration, Greater doses, Other classes of drugs, Alternative combination or SPC, and LSM+. Laboratory tests). Treatment of hypertension in special conditions, including treatment of resistant hypertension, hypertension in women, and perioperative management of hypertension, were also mentioned.The TSOC/THS hypertension guidelines provide the most updated information available in the management of hypertension. The guidelines are not mandatory, and members of the task force fully realize that treatment of hypertension should be individualized to address each patient's circumstances. Ultimately, the decision of the physician decision remains of the utmost importance in hypertension management.

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