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ESC/ESH 2018 Guidelines on Arterial Hypertension

The most essential news in the field of Hypertension is the publication of the 2018 ESC / ESH Guidelines on Arterial Hypertension (1). There are a number of important messages in this text.



The definition of Hypertension remains at 140/90 mm Hg; however, although the goal pressure during treatment can still be 140/90,  new data have shown that long term results are better when pressure is titrated to 130/80 mm Hg; this is also the case in elderly patients and in diabetics. Still, data suggest that in these groups one should not go lower; by contrast, in  “fit” patients, one can try to aim at 120/80 mm Hg (not lower!) unless there are contraindications or bad toleration to antihypertensive drugs. The reader can find more details in the text (1).

Drug treatment of hypertension should be started with a combination of two antiantihypertensive drugs, preferentially in one pill. By doing so, blood pressure control is likely to be much more satisfactory and compliance to treatment better. Obviously, the doses of the drugs need to be carefully titrated toward the blood pressure values obtained as physicians need to remain careful to adapt treatment to what patient is capable or ready to tolerate. Success of this approach is largely depending on a perfect collaboration between patients, physicians and all medical personnel. Time should be taken to explain to the patient and his/her environment on  the rationale of antihypertensive treatment and the consequences of insufficient compliance.

Non-drug treatments  like salt decrease, movement and relaxation … all are very important. One needs to be very attentive on what the patient is able to achieve; clinical experience has taught us that a unrealistic type of treatment will in most cases not  be continued long-term.

It is important to realize that the goal pressure of  140/90 mm Hg is actually not obtained in at least 50% of the cases! All efforts should be made to improve on such figure as this is the only wayto get a substantial reduction  of the risk imposed by high blood pressure. All national and European politicians  should be stimulated to control the heavy weight hypertension caries on cardiovascular prognosis.

References

  1. ESC-ESH Guidelines for the management of arterial hypertension. To be published this fall in European Heart Journal and Journal of Hypertension.