CardioExchange Archive

New hypertension guidelines from the European Society of Hypertension and the European Society of Cardiology were released in Milan today at the European Meeting on Hypertension & Cardiovascular Protection.

The authors of the guidelines write that “despite overwhelming evidence that hypertension is a major cardiovascular risk, studies show that many are still unaware of the condition, that target blood pressure levels are seldom achieved.” They report that hypertension affects 30-45% of people in Europe.

Perhaps the biggest change in the new document is the adoption of a single systolic blood pressure target for almost all patients: 140 mmHg. This replaces the previous, more complicated target, which included both systolic and diastolic recommendations for different levels of risk (140/90 mmHg for moderate- to low-risk patients and 130/80 mmHg for high-risk patients).  One of the co-chairs of the Guidelines Task Force, Robert Fagard, commented: “there was not enough evidence to justify two targets.”

For the first time the European guidelines join the current trend and specifically grade the level of scientific evidence and the strength of recommendations contained in the document.

The approach to drug therapy for hypertension has also been thoroughly revised. Drugs are no longer suggested for the treatment of high normal blood pressure. No single drug or class is given special preference, since the benefits of treatment are largely based on the blood-pressure-lowering effect of the drugs. The guidelines recommend an individualized approach to treatment, based on clinical and demographic considerations.

The guidelines provide perspective on the much-discussed new technology of renal denervation for resistant hypertension, saying that renal denervation is “promising” but that more trials are needed before it can be fully assessed.

The new guidelines put a greater emphasis on considering hypertension within the context of additional cardiovascular and other risk factors. Home blood-pressure monitoring and ambulatory blood-pressure monitoring also gain an increased role.

In a press release, Giuseppe Mancia, Co-Chairperson of the Guidelines Task Force, said:

“This is certainly the most important current overview to consider the totality of hypertension treatment; it will form the basis of hypertension care for the foreseeable future. The WHO has already recognised hypertension as the leading global risk for mortality in the world, and as we identified in the document, the public needs to be more aware of just how common hypertension is. Not only that, doctors and patients need to recognise that we have good treatments which can control hypertension.”

The much-awaited U.S. counterpart to these guidelines have been subjected to multiple delays, to the frustration of many in the hypertension community.