The Egyptian Hypertension Society EGYPTIAN HYPERTENSION GUIDELINES

This is the third version of the Egyptian Hypertension Society (EHS) Guidelines. The guidelines were developed by a working group of 28 members, including cardiologists, nephrologists and internal medicine specialists, who were divided into 6 writing groups and an implementation group. Members reviewed the recent world literature as well as other national and international guidelines. The working groups had a number of meetings over a period of one and half year, before finalizing the document. The Egyptian guidelines were based upon two principles: 1. Address practical issues, 2. Cost containment. They stressed the need for frequent office visits and careful measurement of blood pressure before making a diagnosis of hypertension. Higher threshold for diagnosis of hypertension (150/95 mmHg) was recommended. Ambulatory blood pressure monitoring (ABPM) was indicated in a selected group of patients. Laboratory work-up was kept to the minimum particularly when resources and facilities are limited. The need for lifestyle modification (LSM), controlling obesity and limiting salt intake were stressed. Initiation of pharmacologic treatment, duration of blood pressure monitoring and frequency of office visits were based upon the global cardiovascular risk profile, level of blood pressure and response to LSM. In low risk patients, no drug therapy is recommended when blood pressure is less than 160/100 mmHg. Shorter period of blood pressure monitoring and lower blood pressure threshold (140/90 mmHg) is advised in moderate and high risk patients. In absence of compelling indications any of the five standard pharmacologic groups (diuretics, beta blockers, calcium channel blockers, ACE-inhibitors, angiotensin receptor blockers) can be selected as initial therapy preferably a thiazide diuretic. In absence of satisfactory control of blood pressure, it is recommended to ensure patient's adherence to therapy and lifestyle changes and that he is not taking pressor medications. Obstructive sleep apnea (OSA), white coat hypertension, inadequate diuretic therapy and secondary forms have to be considered as causes for resistant hypertension. Pharmacologic therapy should be modified according to the presence of chronic kidney disease, diabetes, coronary artery disease, heart failure and severity of hypertension. The guidelines addressed management of hypertension in special groups such as obese subjects, the elderly, pregnant women, hypertensive emergencies and patients with valvular heart disease.