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2013 European Hypertension Guidelines

Guideline Watch |
July 23, 2013

2013 European Hypertension Guidelines

  1. JoAnne M. Foody, MD

New recommendations include a near-universal target of 140 mm Hg for systolic blood pressure and selection of drugs for combination therapy based on individual comorbidities.

  1. JoAnne M. Foody, MD

Sponsoring Organizations: European Society of Hypertension, European Society of Cardiology

Background and Purpose: Although much research has been published since these European guidelines were last revised in 2007, the authors state that arterial hypertension “remains a leading cause of death and cardiovascular morbidity.” This update provides important new recommendations for both primary-care and specialist providers.

1. Key Points:

A major development is the recommendation of a single systolic blood pressure (BP) target of 140 mm Hg for virtually all patients. This contrasts with the previously recommended targets of 140/90 mm Hg for moderate- and low-risk patients and 130/80 mm Hg for high-risk patients, which the present authors believe are not supported by current data.

2. Diagnosis and risk assessment. New recommendations include:

  • An expanded role for home BP monitoring, ambulatory BP monitoring, or both as an adjunct to office-based BP measurement

  • A greater emphasis on assessment of global cardiovascular risk

3. Treatment. The guidelines also provide new guidance with regard to antihypertensive drugs:

  • No treatment in patients with high normal BP (Class III)

  • No specific preferences of agents for single-drug or combination therapy

  • An updated protocol for combination therapy focusing not on a hierarchy of medications, but rather on an individualized approach based on patients' comorbidities

  • A particular focus on women during pregnancy with respect to preeclampsia and long-term hypertensive risk and management

  • Specific guidance for managing hypertension in patients with diabetes, the young, and the elderly, including a strategy for drug treatment in octogenarians

Comment

Given the recent abdication by the National Heart, Lung, and Blood Institute of the publication of practice guidelines, this European document is a welcome resource, providing the most comprehensive, evidence-based recommendations available for the management of hypertension. The challenge, as always, is to ensure that the evidence will be translated into practice.

  • Disclosures for JoAnne M. Foody, MD at time of publication Consultant / Advisory board Aegerion; Amarin; Bristol-Myers Squibb; Janssen; Merck; Pfizer; sanofi-aventis Leadership positions in professional societies American College of Cardiology (Cardiosmart, Co-Chair)

Citation(s):

Reader Comments (27)

Master of Education Medical Student, studying in Instituto Politecnico Nacional, Escuela de Medicina y homeopatía, Mexico City

I appreciate the tendency to make exams simpler, individual Approach will always lead to more Details, but not as a Standard.

DR NAUMAN SIDDIQUI FCPS CARDIOLOGY Other Healthcare Professional, Cardiology

great stuff to know but need to be more practical

Davis Other Healthcare Professional

What about the concept of normal being (after age 20) ones age plus 100. ie. age 65 would be 165 systolic?

amir taj khan Fellow-In-Training, Internal Medicine, peshawar pakistan

the main problem regarding the management is monitoring of the BP but did this recommendation can be applied in which already 2007 guidlines are not followe.wt about the managment of distolic hypertension .

Loretta Sernekos, PhD, MSN, AGPCNP-BC Other Healthcare Professional, Family Medicine/General Practice

So glad to see the guidelines relaxed a bit for my patients who are 80+. I had an otherwise healthy, fit 80 year-old patient recently who was becoming quite ill with all the medications his cardiologist was giving him to reduce his SBP below 140. When we relaxed the goal and reduced his meds, his SBP went up to 144-148 and stayed there. Most importantly, he stopped having episodes of dizziness and nausea.

ABDULHAKEEM ALKAMEL Physician, Cardiology, Tehran heart center

Until now there were alot of studies showed that patient with DM and CKD had more benefits of controlling there BP to130/80 and patients well had more events above this target Are all that trials were wrong! !!

Lucy H Jones Other Healthcare Professional, Geriatrics, Functional Independence Rehabilitation

Taking frequent BP before nad after exercise, or treatment session renders more info. Great to see an individualized approach based on patients' comorbidities as the benchmark, rather than drug hierarchy. Reducing polypharmacy may be on the horizon.

Ezio Avanzini - Medical doctor Physician, Internal Medicine, My medical study

Good-concise and useful

Subhahs Telang Physician, Cardiology, Bhavnagar.Gujarat-India.

Sys.Bp130-140 is resonable good control & DBP-80-90.AMBULATORY& HOME BP monitoring is good but,can cause painc in some pt's due to fluctuations during activity & some times faulty inst. results.

Miguel Magraner Physician

Agree that some patients are very anxious and bp monitors are sometimes unriiable. But also there is a hyperetensive response due to stress at office..

Michael Kouimelis, MD Physician, Family Medicine/General Practice, OSF Medical Group: Rockford, Illinois

The summary of the European guidelines is excellent and concise. I am in agreement with their recommendations of a target BP of 140/90 and avoidance of excessively low BP. I was also pleased to see that there was specific mention of our octogenarians and the importance that appropriate BP management has taken in this group.

TAREQ BURGAN MD, MRCP Physician, Internal Medicine, jordan

I think 140 bp is high , knowig that each 10 mmhg above the normal
value increases the risk of stroke by 20% and thi without comorbidities.

JON WILCOX Physician, Family Medicine/General Practice, Auckland New Zealand

Great stuff. It replicates what PCP's have been been saying and suggesting for many years perhaps, but feeling we have been in contempt of "good practice gudelines".

ALBERTO DE LA VEGA BRAVO Physician, Critical Care Medicine, Centro Médico Nacional "20 de Novimebre", México; D.F. Mexico

these selected topics are really usefull and give to me a quick general view of important news and comments that help me in my practice.

Arturo Faieta MD Physician, Cardiology, Policlinica Carúpano Venezuela

I think, this new ESC Guidelines is more realistic than previously published. Reached blood pressure down to 140/90mmhg in certainly patients is difficult (afroamericans, diabetics and renal patients) and inconvenient (elderly patients).

RICHARD GERBER Physician, Internal Medicine

Home blood pressure monitoring is important because 40% of the population have significantly lower blood pressures at home and these readings have the most accurate correlation with prognosis.

Kinfe Gebeyehu Md, MPH Physician, Pediatrics/Adolescent Medicine

I like this simplified guide line both for practitioners and patients and based on supportive data. It sure will help minimize multi drug use both for cost and unnecessary harm. Home BP more regularly with calibrated apparatus and occasional ambulatory BP to justify or R/O white coat hypertension seem practical.

Afizi Kibuuka MBChB, MMED, Physician Physician, Uganda

Thanks , this is good but among special groups, what are the recommendation for breast feeding mothers since most anti hypertensives are secreted in breast milk.
In resource limited settings how often should we screen for the cardiovascular risk factors.

GORDON RAFOOL Physician, Geriatrics, Gessler clinic Florida

It is about time that the BP perimeters are widely circulated. Over the last few years research has shown that BP is controlled when BP is at 140/90. This was based on out come studies in relation to cardiovascular and renal damage. There was no benefit in lowering the BP to a lower value and more harm was done trying to do so. This is partiuliarly true in the case of those 65 and older.To reduce BP to a lower number only served to cause significant orthostatic symptoms that have led to injuries.

Grant Richards Md. Phd. Physician, Cardiology

Report is Brief and to the point refreshing and informative.

Fellow West African college of Physician Physician, Family Medicine/General Practice, Ministry of health, Al ahsa, Saudi Arabia

This guideline is concise and directed to all category of health workers for easy adaptability, particularly for primary health care providers in developing countries.

Samuel Maluil, DO Physician, Family Medicine/General Practice, North Carolina, United States

BP goes up and down with activities of daily living. Having patients monitored BP daily at home creates frustration for many patients and physicians alike as we chase after the numbers. After all, essential hypertension, which is the cause in majority of the patients, will not kill patients today or next year. Therefore, BP monitoring should be done in regular office visits as it has always been down.

gabriel zubillaga Physician, Hospital Medicine, Hospital Universitario Donostia - San Sebastián - Spain

Excellent and comprehensive short, quick reviews of many topics, with a practical summary to apply in our current busy practice, obviating reading large amount of dicussional pages.

Asadullah kundi Physician, Cardiology, National institiute of cardiovascular diseases Karachi Pakistan

I think only few hundred health care providers can record the BP correctly (as per recommendations). The guidelines (European or American) should give due importance to the correct measurement, as few mm Hg error and deprive or over treat patients.
Thanks

CAROL VASSAR Physician, Internal Medicine, Montpelier , VT

to make matters worse, the mercury cuffs are almost all gone. Only a few of us resisted the call to take all mercury tools to the toxic landfill. That drive took safely contained mercury and put it one step closer to toxic leaks into the environment and deprived physicians of the mercury cuffs for checking blood pressure.

Syed Fasih Ahmed Hashmi FCPS Physician, Cardiology

Sir, we have been teaching to our students and GP to achieve lower target for CKD and DM for over a decade.How can convey them the revised targets

Brian Mahood MA FRACP Physician, Pulmonary Medicine, Retired

In essence these guidelines have not altered, apart from no specific cited diastolic pressure, from those which have been already been utilised by physicians for many years. If adopted internationally such standardisation has to have significant benefits for all patients.

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