2018 ESC/ESH Guidelines for management of arterial hypertension
Session chaired by Bryan Williams (London, UK) and Giuseppe Mancia (Milano, Italy).
The 2018 European Society of Cardiology (ESC) and European Society of Hypertension (ESH) Guidelines for treatment of hypertension were presented at the ESC Congress. The definition of hypertension was unchanged as compared with the one in the 2013 Guidelines, with SBP ≥140 mmHg and/or DBP ≥90 mmHg. For diagnosis, in addition to office BP, out-of-office BP measurements can be used, for example ABPM. Other new messages include recommendations for BP-lowering drug treatment in those with high-normal BP (SBP: 130–139/ DBP: 85–89 mmHg) when CV risk is very high and in those with grade I hypertension (SBP: 140-159/DBP: 90–99 mmHg), including older patients (>65 not >80 years), in addition to lifestyle advice.
Treatment targets in all patients are recommended at 130/80 mmHg or lower, and in patients <65 years a BP range of 120 - <130 mmHg is advised. These guidelines pay more attention to hypertension in the elderly. Frailty and biological age rather than chronological age determine the tolerability and benefit of BP-lowering drugs. For patients >65 years the treatment target is 130 - <140 mmHg. Targets should never be <120 mmHg as this could result in adverse effects.
Furthermore, the new guidelines recommend to start with a two-drug combination in most patients as initial therapy to reduce BP, this in contrast to a stepwise treatment in the previous recommendation. As nonadherence plays a major role in poor control of BP and nonadherence increases with the number of pills, two-drug or even three-drug combination in a single tablet “could transform blood pressure control rates”.
For patients with resistant hypertension, addition of spironolactone is recommended. In contrast to the 2013 guidelines, device-based therapy for hypertension is no longer recommended, until further evidence regarding safety and efficacy becomes available.