Global impact of the new European and American hypertension guidelines: A perspective from Lebanon

Under the auspices of the Minister of Public Health Dr. Jamil Jabak, the Faculty of Medicine at Saint Joseph University (USJ) and the Cardiology Department at Hotel Dieu de France (HDF), in collaboration with Sanofi, organized a press conference titled: The global impact of the new European and American hypertension guidelines: A perspective from Lebanon.


Marking the World Hypertension Day, the event highlighted the new hypertension guidelines of the American Heart Association/American College of Cardiology and the European Society of Cardiology/European Society of Hypertension which were published in 2017 and 2018, respectively. The new guidelines introduced significant novelties that have important impact on the prevalence and on the control rate of hypertension worldwide. However, the dissimilarities between these guidelines have placed major challenges for countries outside the USA and Europe particularly where no local hypertension guidelines are available such as Lebanon.


Headed by Prof. Mohamad Haidar, Representing the Minister of Public Health Dr. Jamil Jabbak, Prof. Roland Tomb, Dean of the Faculty of Medicine at USJ, Prof. Antoine Sarkis, President of the Lebanese Society of Cardiology and Prof. Rabih Azar, Chief of the Cardiology Department at HDF, the session discussed the novelties from the Lebanese perspective as the Society of Cardiology is facing the dilemma of which guidelines to follow especially that cardiologists in Lebanon have received advanced training in either the USA or Europe.


“The efforts put behind this study are very much appreciated and valued. The local recommendations can set scientific guidelines to manage hypertension in Lebanon more effectively as well as raising better awareness among Lebanese. This will certainly help reducing the impact of this condition on patients, their caregivers and the healthcare system at large”, Prof. Mohamad Haidar, representing the Minister of Public Health Dr Jamil Jabbak said during his speech. “Within its strategy, the Ministry of Public Health promotes national studies as the outcome of these studies generate local data which means setting the foundation for better management of prevalent conditions and issue relevant health policies rather than relying solely on European and American studies”, he added.


“Clinical and epidemiological research is of great importance for HDF as we believe the findings will contribute to better management of common chronic diseases,” said Prof. Roland Tomb. “The results of the study conducted by Prof. Sarkis and Prof. Azar in 2015 titled “Prevalence, awareness, treatment and control of hypertension” were published in Journal of Clinical Hypertension for the World Hypertension League Organization. This is a solid testimony of the world-class standards we are implementing in our studies,” he added.


The novelties cover three main points. First and most importantly, the definition of hypertension by the American guidelines became 130/80 mm Hg and above while the European guidelines maintained the definition of hypertension at 140/90 mm Hg and above. The second novelty was in the definition of control. The American guidelines recommended reaching a blood pressure below 130/80 mm Hg for all patients, while the European guidelines considered a value of less than 140/90 mm Hg as adequate, with the goal to reach below 130/80 mm Hg in patients below 65 years old. Finally, both recommend using combination therapy in a single pill, as first‐line treatment for patients with blood pressure above 140/90 mm Hg.


From his side, Prof. Antoine Sarkis, President of the Lebanese Society of Cardiology said: “We urge the Lebanese authorities to assess the impact of these guidelines on the prevalence and on the control rate of Hypertension. Based on the latest national study we conducted in 2015 at USJ and HDF, one out of three has hypertension in Lebanon. Only 50% of patients are on treatment and only half of those patients on treatment have their blood pressure controlled. This means that the blood pressure is controlled in only one out of four patients. The study used 140/90 mm Hg as the definition of Hypertension and an on-treatment blood pressure below 140/90 mm Hg as the definition of control. Now, with the difference of the definition between the American and the European guidelines, we need to reassess the local scene so we can agree on the definition of hypertension from a local perspective as this decision will have a major impact on the healthcare system as a whole”.


Commenting on the new study, Prof. Rabih Azar, Head of the Cardiology Department at HDF said: “Taking the study findings we conducted in 2015, if we decided to apply the new American definition of hypertension in Lebanon, then the majority of the Lebanese will become hypertensive and understanding our “culture”, we feel that this would paradoxically minimize the seriousness of the disease, because ‘everyone has it’. Looking into numbers, 58% of the population will be identified as hypertensive, 68% of men and 45% of women. Adding to that, identifying individuals with blood pressure between 130139 mm Hg and/or 8089 mm Hg is beyond our limited resources and even if successful in bringing them to therapy, it may not result in significant reduction in cardiovascular outcome.”


Prof. Azar concluded: “Thus, at this stage, In Lebanon it is preferable to follow the recommendations of Europe and define Hypertension by 140/90 mm Hg and above, and focus on the short term on those who are not aware that they have hypertension, get them diagnosed and put them under treatment to control their blood pressure and avoid unwanted complications”.

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