European guidelines for the management of arterial hypertension 2018-what has changed?

Abstract

In November 2017, the latest American guidelines for the management of arterial hypertension were published. With these guidelines lowering the threshold for hypertension to 130/80 mm Hg, the latest European guidelines were expected with excitement. This article gives an overview on the European Society of Cardiology (ESC) and European Society of Hypertension (ESH) 2018 guidelines for the management of arterial hypertension, thereby identifying the most relevant changes in comparison to previous guidelines. The latest 2018 ESC/ESH guidelines adhere to the previous definition of hypertension, in which ablood pressure of 140/90 mm Hg is considered as threshold for diagnosis. In contrast, there was achange in blood pressure treatment target from below 140/90 to between 120-129/70-79 mm Hg in patients < 65years if well tolerated. Among patients ≥ 65years, asystolic blood pressure between 130 and 139 mm Hg is recommended, whereas adiastolic blood pressure between 70 and 79 mm Hg should be targeted. Additionally the guidelines recommend the use of fixed dose combinations as first choice instead of monotherapy to improve adherence. Interventional treatment strategies should only be applied in carefully selected patients at experienced centers and are not recommended outside of clinical studies and registers. Furthermore, the chapters regarding initiation of blood pressure-lowering therapy and clinical evaluation as well as management of hypertension emergencies have been outlined. The latest European guidelines for the management of hypertension include several changes. One of the most important aspects is that-in contrast to the American guidelines-the threshold for diagnosis remains at 140/90 mm Hg, whereas treatment target range has been lowered by roughly 10 mm Hg and single pill fixed dose combinations are recommended.