New Euro HTN Guidelines Boost Initial Meds, Keep ‘High-Normal’ BP

BARCELONA — The new European guidelines for diagnosing and managing arterial hypertension maintain the previous classification system based on blood pressure  (BP) levels but recommends a harder-hitting initial treatment approach compared to the previous version, released in 2013.

The 2018 European Society of Cardiology (ESC) and European Society of Hypertension (ESH) guidelines document still categorizes patients with systolic/diastolic BP of 130 to 139/85 to 89 mm Hg as having “high-normal” BP. 

But new in 2018, the European guidelines recommend drug therapy to a systolic BP target less than 140 mm Hg for most patients with higher blood pressures but also to less than 130 mm Hg for patients younger than 65 years who can tolerate it.

Those BP treatment thresholds contrast with those in the controversial 2017 US guidelines developed jointly by the American College of Cardiology (ACC), American Heart Association (AHA), and other societies.

They classify the 130 to 139/80 to 89–mm Hg range as stage 1 hypertension. And for most patients with BP in that range or higher, regardless of age, they call for drug therapy to push BP below 130/80 mm Hg.

“We have revised the blood pressure targets, suggesting that all patients, including older patients, should achieve a blood pressure BP less than 140/90 mm Hg as the first objective,” Bryan Williams, MD, University College London, United Kingdom, told | Medscape Cardiology.

Williams co-chaired the 2018 ESC/ESH hypertension guidelines development task force along with Giuseppe Mancia, MD, University of Milano-Bicocca, Italy. They showcased the document, which is scheduled for formal publication in August, here at the ESH’s 28th European Meeting on Hypertension and Cardiovascular Protection.

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