It is widely accepted that hypertension constitutes a significant cardiovascular risk factor and that treating high blood pressure (BP) effectively reduces cardiovascular risk. An important issue in Asia is not just the high prevalence of hypertension, particularly in some countries, but also the low level of awareness and treatment rates in many regions. The 2017 update of the American College of Cardiology/American Heart Association hypertension guidelines raised the question about which BP threshold should be used to diagnose and treat hypertension. Although there is a theoretical rationale for a stricter BP criterion in Asia given the ethnic-specific features of hypertension in the region, the majority of countries in Asia have retained a diagnostic BP threshold of ≥140/90 mm Hg. Although lowering thresholds might make theoretical sense, this would increase the prevalence of hypertension and also markedly reduce BP control rates. In addition, there are currently no data from robust randomized clinical trials of the benefits of the lower targets in preventing cardiovascular disease and reducing cardiovascular risk, particularly in high-risk patients and especially for Asian populations. There is also no defined home BP treatment target level for an office BP treatment target of 130/80 mm Hg. However, in this regard, in the interim, lifestyle modifications, including reducing body weight and salt intake, should form an important part of hypertension management strategies in Asia, while studies on treating at lower BP threshold level in Asians and getting to lower BP targets will be helpful to inform and optimize the management of hypertension in the region.
Bibliographical noteFunding Information:
English language editing assistance was provided by Nicola Ryan, independent medical writer, funded by the HOPE Asia Network.
CH Chen has received honoraria for serving as a speaker or member of a speaker bureau for AstraZeneca, Bayer AG, Boehringer Ingelheim, Bristol‐Myers Squibb, Daiichi Sankyo, Merck & Co, Novartis, Pfizer, Sanofi, Servier, and Takeda. YC Chia has received honoraria for serving as a speaker or advisor for Abbott, Bayer, Boehringer Ingelheim, Merck, MSD, Novartis, Pfizer, Reckitt Benckiser, Sanofi, Servier, and Takeda; sponsorship to scientific conferences from Pfizer and Takeda; and research grants from Pfizer. K Kario has received research grants from A&D Co., Bayer Yakuhin, Boehringer Ingelheim, Daiichi Sankyo,EA Pharma, Fukuda Denshi, Medtronic, Mitsubishi Tanabe Pharma Corporation, Mochida Pharmaceutical Co., Omron Healthcare, Otsuka, Pfizer, Takeda, and Teijin Pharma; and honoraria from Daiichi Sankyo, Omron Healthcare and Takeda. JM Nailes has received speaker's honorarium from Pfizer, and was given investigator initiated research grants from Pfizer. S Park has received honoraria from Astellas and Pfizer; and consultation fees from Takeda. S Siddique has received honoraria from Bayer, Pfizer, ICI, and Servier; and travel, accommodation and conference registration support from Atco Pharmaceutical, Highnoon Laboratories, Horizon Pharma, ICI, Hilton Pharma, CCL and Pfizer.GP Sogunuru has received a research grant related to hypertension monitoring and treatment from Pfizer. All other authors report no potential conflict of interest in relation to this article.
All Science Journal Classification (ASJC) codes
- Internal Medicine
- Endocrinology, Diabetes and Metabolism
- Cardiology and Cardiovascular Medicine