Global Hypertension Guidelines: Are Central Haemodynamics Critical and Neglected

Author(s): Robert A PHILLIPS, Stéphane G CARLIER, Alessandro SCALIA, Philippe DELMOTTE, Giles N CATTERMOLE, Joe BRIERLEY

Hypertension (HTN) is an elevated blood pressure (BP) compared to normative data and occurs in 30-50% of adults and is the number one risk of human death. While non-invasive brachial BP defines hypertension, physiologically BP is the product of the central haemodynamic (CH) variables of stroke volume (SV), heart rate (HR), cardiac output (CO) and systemic vascular resistance (SVR) or BP = (SV x HR) x SVR. Pathophysiologically HTN is the result of one or more elevated CH parameters and while global clinical guidelines recommend anti-hypertensive therapy to reduce CH BP monitoring is recommended to monitor therapeutic effectiveness. Significantly control of people diagnosed with HTN remains persistently dismal at <23% while CH are ignored. We reviewed Australian, Canadian, Chinese, European, Japanese, Singaporean, UK, US and International HTN guidelines. The focus of the guidelines on cardiovascular physiology, allied science and novel concepts of HTN management were assessed using proprietary word-count functions targeting BP and CH, and the results tabulated. A total of 695 pages and 478,537 words were published in the nine representative global HTN guidelines, with BP parameters mentioned 7,535 times (99.4%), and CH parameters mentioned 47 times (0.6%), while 4 of 9 (44%) guidelines omitted any mention of CH. All guidelines recommended BP definitions and BP-centric therapies, without mention of CH. The adoption of CH in HTN practice may improve our understanding of the aetiology of HTN and advance precision therapy in adults and children with this pandemic condition