New Guidelines for Hypertension Treatment
The European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) have updated their guidelines for hypertension treatment. The significant changes are listed below. Click here for the original press release.
- A single systolic blood pressure target of 140 mmHg for almost all
- An increasing role for home blood pressure monitoring, alongside ambulatory blood pressure monitoring
- A greater emphasis on assessing the totality of risk factors for cardiovascular and other diseases. For example, most people with hypertension also have additional risk factors such as organ damage, diabetes, and other cardiovascular risk factors. These need to be considered together before initiating treatment, and during the follow-up
- Special emphasis on specific groups, e.g. diabetics, the young, the elderly, and drug treatment of the over 80s. Women are also considered separately, e.g. during pregnancy. Special consideration is given to new treatments such as renal denervation for resistant hypertension - which is described as "promising", although more trials are called
- New guidance on how and when to take anti-hypertensive drugs. The report indicated no treatment for high normal blood pressure, no specific preference for single drug therapy, and an updated protocol for drugs taken in combination. The guidance takes a liberal attitude to choice of first step drugs, noting the evidence that the beneficial effect of hypertension depends largely on blood pressure lowering. Rather than presenting a hierarchy of drugs (a generic 1st, 2nd, 3rd choice and so on), the approach taken promotes individualized treatment, i.e. to help physicians to decide which drugs to give in which clinical/demographic condition