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Controversies in hypertension management: how low can you go?

ESC Congress News 2019 - Paris, France

The American College of Cardiology/American Heart Association guidelines on hypertension caused quite a stir when they recommended stringent goals for blood pressure (BP) in 2017.1 A debate session this afternoon will hear arguments for and against stricter goals and will also consider whether lifestyle interventions are effective in improving outcomes.


Prof. Bryan WilliamsProfessor Bryan Williams (University College London, London, UK), ESC Task Force Chair for the 2018 ESC/European Society of Hypertension Guidelines2 and a presenter in the debate sets the scene: “In a nutshell, whereas the US guidelines recommend a fairly aggressive blanket approach of reducing BP to 130/80 mmHg for all patients, the new European goals suggest a more tailored, graded approach. The European guidelines recommend reductions of BP below 140/90 mmHg for all patients, with further reductions for young fit patients to 130/80 mmHg and 120–<130/80 mmHg, if possible and if tolerated. When it comes to elderly patients, systolic BP goals of 130–<140 mmHg are recommended.”

Prof. Williams argues that while the decrease in mortality seen in the SPRINT trial3 following systolic BP reduction to 120 mmHg cannot be denied, treatment is about balancing benefits and risk. “Some patients, particularly the elderly, are unlikely to be able to tolerate the side effects of treatment that will accompany intensive treatment, which is why it is important to tailor treatment to suit the individual. Also, data from observational studies suggests that excessive BP lowering can be harmful.” 

He is keen to hear the cases for and against the impact of lifestyle interventions. “Lifestyle interventions promote general good health and can reduce BP and treatment requirements. However, because there are no randomised trials, we don’t know if they actually contribute to reducing cardiovascular events or deaths. The other problem is that this approach is not feasible long-term for most people, who are unable to maintain the changes.”

Prof. Williams concludes that, “The discussion generated by the US BP guidelines is still going strong. I am very excited to be taking part in this afternoon’s debate and I look forward to seeing where the consensus of opinion will lie.”

Don’t miss!

Controversies in hypertension management
Today, 16:40 – 17:50; Duras – The Hub


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  1. Whelton PK, et al. J Am Coll Cardiol 2018;71:e127–e248.
  2. 2. Williams B, et al. Eur Heart J 2018;39:3021–3104.
  3. 3. SPRINT Research Group. N Engl J Med 2015;373:2103–2116.

Notes to editor

About the European Society of Cardiology

The European Society of Cardiology brings together healthcare professionals from more than 150 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.

About ESC Congress 2019

ESC Congress is the world’s largest and most influential cardiovascular event contributing to global awareness of the latest clinical trials and breakthrough discoveries. ESC Congress 2019 takes place 31 August to 4 September at the Paris Expo Porte de Versailles, Paris - France. Explore the scientific programme