ESH-ESC guidelines for the management of hypertension
- PMID: 16810473
- DOI: 10.1007/s00059-006-2829-3
ESH-ESC guidelines for the management of hypertension
Abstract
The following is a brief statement of the 2003 European Society of Hypertension (ESH)-European Society of Cardiology (ESC) guidelines for the management of arterial hypertension. The continuous relationship between the level of blood pressure and cardiovascular risk makes the definition of hypertension arbitrary. Since risk factors cluster in hypertensive individuals, risk stratification should be made and decision about the management should not be based on blood pressure alone, but also according to the presence or absence of other risk factors, target organ damage, diabetes, and cardiovascular or renal damage, as well as on other aspects of the patient's personal, medical and social situation. Blood pressure values measured in the doctor's office or the clinic should commonly be used as reference. Ambulatory blood pressure monitoring may have clinical value, when considerable variability of office blood pressure is found over the same or different visits, high office blood pressure is measured in subjects otherwise at low global cardiovascular risk, there is marked discrepancy between blood pressure values measured in the office and at home, resistance to drug treatment is suspected, or research is involved. Secondary hypertension should always be investigated. The primary goal of treatment of patient with high blood pressure is to achieve the maximum reduction in long-term total risk of cardiovascular morbidity and mortality. This requires treatment of all the reversible factors identified, including smoking, dislipidemia, or diabetes, and the appropriate management of associated clinical conditions, as well as treatment of the raised blood pressure per se. On the basis of current evidence from trials, it can be recommended that blood pressure, both systolic and diastolic, be intensively lowered at least below 140/90 mmHg and to definitely lower values, if tolerated, in all hypertensive patients, and below 130/80 mmHg in diabetics. Lifestyle measures should be instituted whenever appropriate in all patients, including subjects with high normal blood pressure and patients who require drug treatment. The purpose is to lower blood pressure and to control other risk factors and clinical conditions present. In most, if not all, hypertensive patients, therapy should be started gradually, and target blood pressure achieved progressively through several weeks. To reach target blood pressure, it is likely that a large proportion of patients will require combination therapy with more than one agent. The main benefits of antihypertensive therapy are due to lowering of blood pressure per se. There is also evidence that specific drug classes may differ in some effect or in special groups of patients. The choice of drugs will be influenced by many factors, including previous experience of the patient with antihypertensive agents, cost of drugs, risk profile, presence or absence of target organ damage, clinical cardiovascular or renal disease or diabetes, patient's preference.
Similar articles
-
[Treatment of hypertensive type 2 diabetics: too late, too little].Herz. 2008 Apr;33(3):191-5. doi: 10.1007/s00059-008-3117-1. Herz. 2008. PMID: 18568313 Review. German.
-
Treatment of hypertension in chronic kidney disease.Semin Nephrol. 2005 Nov;25(6):435-9. doi: 10.1016/j.semnephrol.2005.05.016. Semin Nephrol. 2005. PMID: 16298269 Review.
-
The 2005 Canadian Hypertension Education Program recommendations for the management of hypertension: part II - therapy.Can J Cardiol. 2005 Jun;21(8):657-72. Can J Cardiol. 2005. PMID: 16003449
-
The 2004 Canadian recommendations for the management of hypertension: Part II--Therapy.Can J Cardiol. 2004 Jan;20(1):41-54. Can J Cardiol. 2004. PMID: 14968142
-
The 2004 Canadian Hypertension Education Program recommendations for the management of hypertension: Part I--Blood pressure measurement, diagnosis and assessment of risk.Can J Cardiol. 2004 Jan;20(1):31-40. Can J Cardiol. 2004. PMID: 14968141
Cited by
-
A retrospective prognostic evaluation using unsupervised learning in the treatment of COVID-19 patients with hypertension treated with ACEI/ARB drugs.PeerJ. 2024 May 13;12:e17340. doi: 10.7717/peerj.17340. eCollection 2024. PeerJ. 2024. PMID: 38756444 Free PMC article.
-
A Novel Online Calculator Predicting Acute Kidney Injury After Liver Transplantation: A Retrospective Study.Transpl Int. 2023 Jan 19;36:10887. doi: 10.3389/ti.2023.10887. eCollection 2023. Transpl Int. 2023. PMID: 36744052 Free PMC article.
-
National Hypertension Guidelines: A Review of the India Hypertension Control Initiative (IHCI) and Future Prospects.Cureus. 2022 Aug 14;14(8):e27997. doi: 10.7759/cureus.27997. eCollection 2022 Aug. Cureus. 2022. PMID: 36134089 Free PMC article. Review.
-
The Relationship Between Admission Blood Pressure and Clinical Outcomes for Acute Basilar Artery Occlusion.Front Neurosci. 2022 Jun 21;16:900868. doi: 10.3389/fnins.2022.900868. eCollection 2022. Front Neurosci. 2022. PMID: 35801181 Free PMC article.
-
Effects of Different Antihypertensive Drug Combinations on Blood Pressure and Arterial Stiffness.Med Arch. 2019 Jun;73(3):157-162. doi: 10.5455/medarh.2019.73.157-162. Med Arch. 2019. PMID: 31391706 Free PMC article.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical