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The 2013 ESC/ESH Guidelines for hypertension: hot topics

Hypertension


The session was devoted to the presentation and discussion of the most important issues of the 2013 hypertesion guidelines of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). The novelties, refinements and modifications of the previous 2007 guidelines were the main aspects discussed. The 2013 ESH/ESC guidelines continue with the fundamental principles that inspired the previous guidelines, namely:
1) recommendations based on well-conducted studies identified from an extensive review of the literature;
2) consideration of data from randomized, controlled trials (RCTs) and their meta-analyses, but not disregarding the results of observational and other studies of appropriate scientific calibre; and
3) grading the level of scientific evidence and the strength of recommendations on major diagnostic and treatment issues as in European guidelines on other diseases, according to ESC recommendations. A fourth principle, in line with its educational purpose, is to provide a large number of tables and a set of concise recommendations that could be easily and rapidly consulted by physicians in their routine practice. The recommendations issued by the 2013 ESH/ESC guidelines on hypertension largely reflect the state of the art on hypertension, as viewed by scientists and physicians in Europe.

Because of new evidence on several diagnostic and therapeutic aspects of hypertension, the present guidelines differ in many respects from the previous ones. The most important new aspects are:
1) Epidemiological data on hypertension and blood pressure (BP) control in Europe;
2) Strengthening of the prognostic value of home blood pressure monitoring (HBPM) and its role for diagnosis and management of hypertension, next to ambulatory blood pressure monitoring (ABPM);
3) Update of the prognostic significance of night-time BP, white coat hypertension and masked hypertension;
4) Re-emphasis on the integration of BP, cardiovascular (CV) risk factors, asymptomatic organ damage and clinical complications for total CV risk assessment;
5) Update of the prognostic significance of asymptomatic organ damage, including heart, blood vessels, kidneys, eyes and brain;
6) Initiation of antihypertensive treatment;
7) Target BP for treatment;
8) Revised schema for preferred drug combinations;
9) Extended section on therapeutic strategies in special conditions (elderly, octogenarians...);
10) Special attention to resistant hypertension and new treatment approaches; and
11) New approaches to chronic management of hypertensive disease.

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The 2013 ESC/ESH Guidelines for hypertension: hot topics

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.