ABC | Volume 113, Nº4, October 2019

Updated Updated Cardiovascular Prevention Guideline of the Brazilian Society Of Cardiology – 2019 Arq Bras Cardiol. 2019; 113(4):787-891 Chart 5.3 – Recommendations on how to approach adults with high blood pressure or arterial hypertension Recommendation Recommendation grade Level of evidence Reference Non-pharmacological measures are indicated for all adults with high BP or hypertension to reduce BP: weight loss, healthy eating habits, low sodium intake, dietary potassium supplementation, increased physical activity with a structured training program, and limited alcohol consumption I A 9,10,155,164,189 Antihypertensive drugs are recommended for adults at estimated risk ≥ 10% in 10 years and average SBP ≥ 130 mmHg or average DBP ≥ 80 mmHg, for primary prevention of CVD I A 9,10,155,164,189 A BP target < 130/80 mmHg is recommended for adults with confirmed hypertension and CV risk ≥ 10% I B 9,10,155,164,189 A BP target < 130/80 mmHg is recommended for adults with arterial hypertension and chronic kidney disease I B 9,10,155,164,189 A BP target < 130/80 mmHg, which should start if BP ≥ 130/80 mmHg, is recommended for adults with arterial hypertension and type 2 diabetes I B 9,10,155,164,189 Antihypertensive drugs are recommended for adults at estimated risk < 10% in 10 years and average BP ≥ 140/90 mmHg for primary prevention of CVD I C 9,10,155,164,189 In adults with confirmed hypertension, without additional markers of increased CV risk, the recommended BP target is < 130/80 mmHg IIb B 9.10,155,164, 189 BP: blood pressure; CVD: cardiovascular disease; DBP: diastolic blood pressure; SBP: systolic blood pressure. the beneficial effect of a low-sodium diet on BP, mainly due to the increased intake of potassium, known for reducing BP. It is possible to prevent or postpone AH with a change in lifestyle, which can effectively promote the primary prevention of systemic arterial hypertension (SAH), especially in individuals with borderline BP. 10 Healthy lifestyle habits should be adopted since childhood and adolescence, respecting the regional, cultural, social, and economic characteristics of individuals (Chart 5.3). Figure 5.1 – Flowchart for the diagnosis of arterial hypertension. BP: blood pressure; ABPM: ambulatory BP monitoring; HBPM: home BP monitoring. Modified from references. 9,10,189 5.8. Antihypertensive Control in Primary Prevention of Diabetes Mellitus and Metabolic Syndrome BP control is one of the more robust tools for reducing CV risk. Reducing 20 mmHg in SBP can decrease CAD mortality by 40%, CVA mortality by 50%, and HF mortality by 47%. However, AH is still the most common and potent risk factor for loss of life expectancy, due to the suboptimal population control of this condition. 190-192 High BP ≥ 180/110 mmHg Rule out hypertensive urgency/emergency and refer the patient to the Emergency Confirmed diagnosis Identify target-organ damage Follow-up at least annually White coat hypertension The difference between the BP measure at the doctor's office and those from ABPM or HBPM is ≥ 20 mmHg for SBP and/or ≥ 10 mmHg for DBP Masked hypertension Normal BP at the doctor's office Consider ABPM or HBPM if the BP reported differs from the one obtained in the outpatient clinic High BP 130-139/80-89 mmHg Low/moderate cardiovascular risk Non-pharmacological measures High BP 130-139/80-89 mmHg Low/moderate cardiovascular risk Start non-pharmacological and plarmacological measures High BP ≥ 120-129/ < 80 mmHg (at least 2 times) Start non-pharmacological measures 816