Treatments for arterial hypertension: the advice from HAS

March 2017
Treating arterial hypertension: HAS makes some recommendations

Arterial hypertension is a risk factor of cardiovascular accident. It is thus necessary to deal with concerned adults in order to prevent this risk as well as possible. The treatment, pharmaceutical or not, are essential. In a document of July 2005, the HAS focuses on dealing with hypertensive patients. Let's focus on the processing.


Hypertensive?

Hypertension

If, during 3 visits in an interval from 3 to 6 months, a patient, to whom blood pressure is measured twice, has results equal to or higher than 140 mmHg for the PSA and/or 90 mmHg for the PSD, then he is regarded as hypertensive.

total Cardiovascular risk

The treatment to be given will be decided after a cardiovascular estimate of the total risk. To evaluate this risk, the HAS proposes to focus on the following risk factors:
  • Age (> 50 for man and > 60 for woman)
  • Nicotinism (current nicotinism or give up since less than 3 years)
  • Family history of early cardiovascular accident (myocardial infarction or sudden death: before the age of 55 years in the father or a relative of the 1st degree of male sex or before the 65 years age in the mother or a relative of the 1st degree of female sex)
  • Early cerebrovascular accident (< 45 years)
  • Diabetes (treated diabetes or not treated)
  • Dyslipidemia (LDL-cholesterol ? 1,60 g/l (4,1 mmol/L) and HDL-cholesterol ? 0,40 g/l (1 mmol/L whatever the sex).


Other parameters include abdominal obesity or sedentariness. The doctor must also evaluate the target organs affected and detect the cardiovascular and renal illness.

The HAS offers a table of stratification of the risk levels according to:

medium

Treatment

Non medicinal

The non medicinal treatment of arterial hypertension consists in making the patient adopt a certain number of hygiene and nutritional measures.

For example:
  • Limitation of salt consumption,
  • Smoking-cessation,
  • Doing sports regularly,
  • Adopting a diet rich in vegetables, fruits and low in saturated fats.


"The hygiene nutritional measures are recommended for all hypertensive patients, whatever the blood pressure level, with or without associated pharmacological treatment" specifies the HAS.

Medicinal

"The benefit of pharmacological treatment is above all depend on blood-pressure lowering, whatever the class of the used antihypertensive." To treat the noncomplicated essential HTA, 5 categories of hypertenseurs are recommended:
  • Diuretics thiazidic,
  • Beta blocking agent,
  • Calcium antagonists,
  • Converting-enzyme inhibiters (IEC),
  • Angiotensin II receptor antagonists (ARA II).


The choice of the hypertensor depends on several criteria such as the particular clinical situations, efficiency and tolerance, associated comorbidities ...

The HAS advises to follow the medication adjustment strategy:
  • Begin with a monotherapy or a fixed association of antihypertensives at weak doses (having AMM in first intention for HTA indication)
  • In the event of insufficient tensionnelle answer to the initial process: bitherapy in second intention within at least 4 weeks
  • To set a bitherapy within a shorter time if:
    • PA ? 180-110 mmHg
    • PA de 140-179/90-109 mmHg with a high RCV


After 4 weeks of an initial process:
  • If the tensional objective is achieved, the treatment is renewed,
  • In the event of complete absence of answer to this treatment or side effects, it is recommended to change the therapeutic class.


The following diagram (HAS) shows the combinations of efficient therapeutic classes validated by clinical studies:

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Source

Find the entire recommendations of the HAS: Prise en charge des patients adultes atteints d'hypertension artérielle essentielle - Actualisation 2005.

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Tratamientos de la hipertensión arterial
Tratamientos de la hipertensión arterial
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