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New Guidelines for Management of Arterial Hypertension

Recommendations introduced at European blood pressure conference (June 14)

New guidelines, which recommend several significant changes to hypertension treatment, have been issued by the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC). The guidelines were announced June 14 at the ESH congress in Milan, Italy, with simultaneous online publication in the Journal of Hypertension, the European Heart Journal, and Blood Pressure.

First issued in 2003, the original version of the joint ESH/ESC guidelines for the management of arterial hypertension became one of the most highly-cited medical papers in the world. The 2013 guidelines — which replace the 2007 edition — offer recommendations that show how the hypertension landscape has changed, and indicate what needs to be done to reduce mortality and morbidity from hypertension and associated conditions.

According to the report, lifestyle changes are the cornerstone for the prevention of hypertension. These changes include reducing salt (to roughly half the present levels) and alcohol, maintaining a healthy body weight, exercising regularly, and eliminating smoking.

The guidelines highlight the lack of awareness of the potential problems of hypertension among patients, with poor long-term adherence to treatment, and the “inertia” of doctors, who don’t take appropriate action when confronted with patients with uncontrolled blood pressure.

The authors state that “despite overwhelming evidence that hypertension is a major cardiovascular risk, studies show that many are still unaware of the condition, [and] that target blood pressure levels are seldom achieved.”

A major development is the decision to recommend a single systolic blood pressure target of 140 mm Hg for almost all patients. This contrasts with the 2007 version, which recommended a 140/90 mm Hg target for moderate- to low-risk patients, and a 130/80 mm Hg target for high-risk patients.

Other changes include:

  • An increasing role for home blood pressure monitoring, alongside ambulatory blood pressure monitoring.
  • A greater emphasis on assessing the totality of risk factors for cardiovascular and other diseases. For example, most people with hypertension also have additional risk factors, such as organ damage, diabetes, and other cardiovascular risk factors. These need to be considered together before initiating treatment, and during the follow-up.
  • Special emphasis on specific groups, e.g., diabetics, the young, the elderly, and drug treatment of patients older than 80.
  • New guidance on how and when to take anti-hypertensive drugs.

Source: ESC; June 14, 2013.

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