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Israel Hypertension Society adopts ‘successful’ British guidelines
By JUDY SIEGEL-ITZKOVICH
04/12/2013
Hypertension can usually be treated by changes in the diet and by taking medications.
 
The Israel Hypertension Society (IHS), a group of some 500 physicians and scientists with expertise in high blood pressure, has followed the lead of NICE, the British National Institute for Health and Care Excellence, which nearly three years ago updated its guidelines for treatment.

IHS is thus the second such body in the world to adopt the NICE guidelines, which for years, according to Prof.

Jonathan Sharabi, who chairs the IHS, have been opposed by the American, European and other hypertension societies largely due to different calculations of cost effectiveness.

On Wednesday, Sharabi, who works at Sheba Medical Center at Tel Hashomer, described the new guidelines at a national conference.

High blood pressure – called the “quiet killer” – affects about a million Israelis over the age of 18 and can be treated.

Untreated, it can lead to heart attacks, strokes, kidney disease and other serious problems.

Sharabi explained to The Jerusalem Post that even though NICE endorsed the new guidelines some time ago, Israeli experts first wanted to examine them carefully, as there are genetic, dietary, psychological and other factors that could cause differences in the disease between countries.

The Health Ministry in Jerusalem did not comment on the new IHS guidelines, compiled by 15 local professors, because it leaves this to medical societies and national councils devoted to specific medical topics.

The society differentiates between adults aged 18 to 40 and those over 40. For the first group, people who have had a high blood pressure reading at home or in a doctor’s office should be referred by the family physician for automatic, 24-hour monitoring by a Holter machine. The monitor can be obtained from the health fund or at a hospital outpatient clinic.

The Holter is a portable ambulatory electrocardiography device for continuous monitoring of various electrical activity of the cardiovascular system. (It can also be used to monitor brain activity, irregular heartbeat or epileptic events.) The monitoring is paid for by the health fund, as it is part of the basket of health services.

Above age 40, individuals should purchase a digital sphygmomanometer (blood pressure testing machine) sold in any pharmacy and, while in a sitting position during the morning and evening, check their blood pressure for a week. Digital machines keep records of recent readings.

Sharabi noted that every six months, the device’s batteries should be changed.

Anyone found to have excessively high readings – they vary according to age, but most should be under 140/90 – should be sent for blood tests, including sodium levels, kidney function, liver function, thyroid and tests for protein in the urine (creatinine).

Hypertension can usually be treated by changes in the diet and by taking medications.

“There is a big repertoire of prescription medications for this,” said Sharabi, but the new guidelines recommend taking at least two different drugs simultaneously instead of only one.

Usually, a family physician can handle the condition if trained to deal with it, but if one also has other risks, including smoking, emotional stress, high cholesterol or diabetes, patients should be referred to a hypertension specialist.

Such specialists include nephrologists (kidneys), cardiologists and endocrinologists (who deal with the hormonal system).

The society recently opened a fellowship in hypertension, so, according to Sharabi, in another year the knowhow in treating the condition will expand.

He noted that because of the consumption of kosher meat that is salted and rinsed before reaching the consumer, blood pressure levels are higher.

But Israelis seem to consume less prepared junk foods than Americans, so the levels balance out to make them similar. The average Israeli consumes eight or nine grams of sodium per day, he said.

“There are many, many ways in which hypertension has been treated in the past,” said Sharabi. “Our guidelines created order from the chaos so it will now be like a playlist of songs.”

He said that when looking at blood pressure levels in Britain since the new NICE guidelines were issued, control of hypertension had dramatically improved.
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