National and international guidelines for the management of cardiovascular disease
| Organization (year) | Recommendation |
|---|---|
| European Association of Preventive Cardiology and the European Society of Cardiology (ESC) Council on Hypertension (2022)59 | Patients with hypertension are advised to engage in at least 30 min of moderate-intensity aerobic exercise such as walking, jogging, cycling, or swimming on 5–7 d/wk for at least 150 min/wk. In addition, dynamic resistance exercises but not isometric exercises are recommended 2–3 d/wk. |
| National Institute for Health and Care Excellence (2019)60 | Diagnosing Hypertension: It is recommended that diagnosis is based on out-of-office measurement, given the risk of white-coat hypertension, defined as a difference of > 20/10 mm Hg between clinic readings and average daytime home or ambulatory measurements. The gold standard is ambulatory blood pressure monitoring but, as this is not suitable or tolerated by everyone, home blood pressure monitoring is offered as an alternative. For home blood pressure monitoring, patients should be advised to take at least 2 recordings, 1 min apart, twice a day for 4 to 7 d. The first day of readings should be discounted and the mean of the remaining readings used. |
| KDIGO (2021)61 | We suggest that adults with high BP and chronic kidney disease be treated with a target systolic BP of < 120 mm Hg, when tolerated, using standardized office BP measurement. |
| American Diabetes Association (2021)62 | Among patients with type 2 diabetes who have established atherosclerotic cardiovascular disease or established kidney disease, a SGLT2 inhibitor or glucagon-like peptide 1 receptor agonist with demonstrated cardiovascular disease benefit is recommended as part of the comprehensive cardiovascular risk reduction or glucose-lowering regimens. |
| ASA therapy (75–162 mg/d) may be considered as a primary prevention strategy in those with diabetes who are at increased cardiovascular risk, after a comprehensive discussion with the patient on the benefits versus the comparable increased risk of bleeding. | |
| ESC, with the European Association for Cardio-Thoracic Surgery and the ESC European Heart Rhythm Association (2020)63 | For stroke risk assessment, a risk factor–based approach is recommended, using the CHA2DS2-VASc clinical stroke risk score to initially identify patients at “low stroke risk” (CHA2DS2-VASc score = 0 in men, or 1 in women) who should not be offered antithrombotic therapy. |
| ESC, with the ESC Heart Failure Association (2021)64 | SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin, ertugliflozin, sotagliflozin) are recommended in patients with type 2 diabetes mellitus at risk of cardiovascular events to reduce hospital admissions for heart failure, major cardiovascular events, end-stage renal dysfunction and cardiovascular death. |
| World Health Organization (2020)65 | It is recommended that all adults undertake regular physical activity. Adults should do at least 150–300 min of moderate-intensity aerobic physical activity, or at least 75–150 min of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate-intensity and vigorous-intensity activity throughout the week for substantial health benefits. Adults should also do muscle-strengthening activities at moderate or greater intensity that involve all major muscle groups on 2 or more days a week, as these provide additional health benefits. |
Note: ASA = acetylsalicylic acid, BP = blood pressure, CHA2DS2-VASc = congestive heart failure or left ventricular dysfunction; hypertension; age ≥ 75 yr (doubled); diabetes; stroke or TIA (doubled) — vascular disease, age 65–74 yr, sex category (female), ESC = European Society of Cardiology, SGLT2 = sodium–glucose cotransporter 2.