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The 2013 ESH/ESC Guidelines on arterial hypertension

Hypertension


This session analysed the most relevant recommendations of the new joint ESC-ESH guidelines on hypertension. Many of them confirm the previous guidelines released in 2007, but there has been refinement of some recommendations, and also formulation of some new ones in the areas of diagnosis, risk evaluation, goals and how to achieve them, and treatment in specific clinical conditions.

Prof. Fagard (Leuven, BE) presented the most relevant novelties in diagnosis. Mainly, he underlined the role of out-of-office blood pressure (BP) measurements. Out-of-office BP should be considered to confirm the diagnosis of hypertension, identify the type of hypertension, detect hypotensive episodes, and maximize prediction of CV risk. For out-of-office BP measurements, ambulatory or home blood pressure monitoring may be considered, depending on indication, availability, ease, cost of use and, if appropriate, patient preference.

Prof. Laurent (Paris, FR) reviewed the importance of early organ damage assessment in the risk stratification strategy. Left ventricular mass, glomerular filtration rate, microalbuminuria are the minimal requirements of organ damage assessment, although evaluation of parameters of large arteries, such as Pulse Wave Velocity, can be useful. The importance of organ damage assessment during the follow-up of antihypertensive treatment is reinforced, although some new information will be required.

Prof. Mancia (Milan, IT) analysed the general treatment recommendations. Systolic blood pressure < 140 mmHg is recommended regardless the level of risk in low/moderate risk, diabetes, diabetic/nondiabetic CKD and patients with CHD/previous stroke or transient ischemic attack. For diastolic BP, < 90 mmHg recommended. In patients with diabetes, diastolic BP values < 85 mmHg are recommended. In elderly hypertensives (<80 years old) there is solid evidence to recommend reducing systolic BP to between 150-140 mmHg. Physicians should consider a SBP <140 mmHg in fit elderlies, with the same SBP target in individuals older than 80 years (IB). This recommendation applies to octogenarians in good physical/mental condition.

Finally, Prof. Cifkova (Prague, CZ) analysed the particularities of treatment in special conditions, which include the most frequent comorbidities as well as treatment in special situations such as women, young patients, and subjects with resistant hypertension.

References


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SessionTitle:

The 2013 ESC/ESH Guidelines on arterial hypertension

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.