First messages from the 2018 ESC/ESH Guidelines for treatment of hypertension
A first presentation on the new 2018 European Society of Cardiology (ESC) and European Society of Hypertension (ESH) Guidelines for treatment of hypertension was given at the ESH conference in Barcelona on June 9, 2018. One of the main messages was the unchanged classification of blood pressure (BP) and the definition of hypertension from previous European guidelines with an office systolic BP (SBP) >140 mmHg and/or diastolic BP (DBP) >90 mmHg, in contrast to the new definition in the 2017 ACC/AHA Hypertension Guidelines (>130/80 mmHg).
One of the reasons for leaving the classification and definition of hypertension unchanged, was the difficulty of interpreting the results of the SPRINT trial according to the Task Force of the ESC/ESH guidelines, as BP was measured differently in this trial compared to other trials. White coat hypertension was not present in SPRINT due to unattended BP measurement and resulted in lower BP values. The authors suggested that SPRINT BP values may correspond to a higher conventional office SBP (130-140 for the more intensively treated group, and 140-150 for the less intensively treated group).
Updates in the new guidelines include a lower BP threshold and treatment target for older patients (<140/90 mmHg and for those ≥80 years <160/90 mmHg). For all patients, the first treatment objective should be to lower BP to <140/90 mmHg, and provided that therapy is well tolerated a target of <130 mmHg should be applied. For most patients a two-drug combination of treatment is recommended as initial therapy and preferred combinations are a RAS blocker (ACEi or ARB) with CCB or diuretic. Ideally this two-drug combination will be taken as a single pill therapy, to improve adherence.
One of the lead authors of the new guidelines, Professor Giuseppe Mancia (Milan, Italy) said: “The 2018 ESC/ESH guidelines issue new recommendations on how to optimally treat hypertension. Drug therapy extends to additional groups of patients. Also, blood pressure values to aim at with treatment are lower than in the past. In addition, combination therapy is now recognized as the most effective initial treatment strategy in most patients.”
The full text of the ESC/ESH Guidelines for the Management of Arterial Hypertension will be published on 25 August 2018 and presented during the ESC Congress 2018 in Munich (August 25-29, 2018).