Speciality Medical Dialogues
    • facebook
    • twitter
    Login Register
    • facebook
    • twitter
    Login Register
    • Medical Dialogues
    • Education Dialogues
    • Business Dialogues
    • Medical Jobs
    • Medical Matrimony
    • MD Brand Connect
    Speciality Medical Dialogues
    • Editorial
    • News
        • Anesthesiology
        • Cancer
        • Cardiac Sciences
        • Critical Care
        • Dentistry
        • Dermatology
        • Diabetes and Endo
        • Diagnostics
        • ENT
        • Featured Research
        • Gastroenterology
        • Geriatrics
        • Medicine
        • Nephrology
        • Neurosciences
        • Nursing
        • Obs and Gynae
        • Ophthalmology
        • Orthopaedics
        • Paediatrics
        • Parmedics
        • Pharmacy
        • Psychiatry
        • Pulmonology
        • Radiology
        • Surgery
        • Urology
    • Practice Guidelines
        • Anesthesiology Guidelines
        • Cancer Guidelines
        • Cardiac Sciences Guidelines
        • Critical Care Guidelines
        • Dentistry Guidelines
        • Dermatology Guidelines
        • Diabetes and Endo Guidelines
        • Diagnostics Guidelines
        • ENT Guidelines
        • Featured Practice Guidelines
        • Gastroenterology Guidelines
        • Geriatrics Guidelines
        • Medicine Guidelines
        • Nephrology Guidelines
        • Neurosciences Guidelines
        • Obs and Gynae Guidelines
        • Ophthalmology Guidelines
        • Orthopaedics Guidelines
        • Paediatrics Guidelines
        • Psychiatry Guidelines
        • Pulmonology Guidelines
        • Radiology Guidelines
        • Surgery Guidelines
        • Urology Guidelines
    LoginRegister
    Speciality Medical Dialogues
    LoginRegister
    • Home
    • Editorial
    • News
      • Anesthesiology
      • Cancer
      • Cardiac Sciences
      • Critical Care
      • Dentistry
      • Dermatology
      • Diabetes and Endo
      • Diagnostics
      • ENT
      • Featured Research
      • Gastroenterology
      • Geriatrics
      • Medicine
      • Nephrology
      • Neurosciences
      • Nursing
      • Obs and Gynae
      • Ophthalmology
      • Orthopaedics
      • Paediatrics
      • Parmedics
      • Pharmacy
      • Psychiatry
      • Pulmonology
      • Radiology
      • Surgery
      • Urology
    • Practice Guidelines
      • Anesthesiology Guidelines
      • Cancer Guidelines
      • Cardiac Sciences Guidelines
      • Critical Care Guidelines
      • Dentistry Guidelines
      • Dermatology Guidelines
      • Diabetes and Endo Guidelines
      • Diagnostics Guidelines
      • ENT Guidelines
      • Featured Practice Guidelines
      • Gastroenterology Guidelines
      • Geriatrics Guidelines
      • Medicine Guidelines
      • Nephrology Guidelines
      • Neurosciences Guidelines
      • Obs and Gynae Guidelines
      • Ophthalmology Guidelines
      • Orthopaedics Guidelines
      • Paediatrics Guidelines
      • Psychiatry Guidelines
      • Pulmonology Guidelines
      • Radiology Guidelines
      • Surgery Guidelines
      • Urology Guidelines
    • Home
    • Practice Guidelines
    • Cardiac Sciences Guidelines
    • Management of High...

    Management of High Blood Pressure - Latest 2018 ESC/ESH Guidelines

    Written by Dr. Kamal Kant Kohli Kohli Published On 2018-08-28T19:03:25+05:30  |  Updated On 28 Aug 2018 7:03 PM IST
    Management of High Blood Pressure - Latest 2018 ESC/ESH Guidelines

    ESHThe European Society of Cardiology (ESC) and the European Society of Hypertension (ESH) have jointly released recommendations for management of high blood pressure or arterial hypertension in adults aged ≥18 years during recently held ESC Congress 2018. The updated guideline has been published in the European Heart Journal and replaces the one released in 2013.


    The latest European guidelines recommend 140/90mmHg as high blood pressure contrary to ACC/AHA guidelines which lowered the threshold of High B.P to130/80.


    Comparison of Updated Guideline with the previous Guideline :



















































































    20132018
    DiagnosisDiagnosis
    Office BP is recommended for screening and diagnosis of hypertension.It is recommended to base the diagnosis of hypertension on:

    · Repeated office BP measurements: or

    · Out -of-office BP measurements with ABPM and/or HBPM if logistically and economically feasible.
    Treatment thresholds

    High normal BP (130-139/85-89 mmHg): unless the

    Necessary evidence is obtained, it is not recommended to initiate antihypertensive drug therapy at high-normal BP.
    Treatment thresholds

    High normal BP (130-139/85-89 mmHg): drug treatment may bay considered when CV risk is very high due to established CVD, especially CAD.
    Treatment thresholds

    Treatment of low-risk grade 1 hypertension:

    Initiation of antihypertensive drug treatment should also be considered in grade 1 hypertensive patients at low-moderate-risk, when BP is within this range at several repeated visits or elevated by ambulatory BP criteria, and remains within this range despite a reasonable period of time with lifestyle measures.
    Treatment thresholds

    Treatment of low-risk grade 1 hypertension:

    In patients with grade 1 hypertension at low-moderate-risk and without evidence of HMOD, BP-lowering drug treatment is recommended if the patient remains hypertensive after a period of lifestyle intervention.
    Treatment thresholds

    Older patients

    Antihypertensive drug treatment may be considered in the elderly (at least when younger than 80 years) when SBP is in the 140-159 mmHg range, provided that antihypertensive treatment is well tolerated.
    Treatment thresholds

    Older patients

    BP-lowering drug treatment and lifestyle intervention is recommended in fit older patients (>65 years but not>80 years) when SBP is in the grade 1 range (140-159 mmHg), provided that treatment is well tolerated.
    BP treatment targetsBP treatment targets
    An SBP goal of <140 mmHg is recommended· It is recommended that first objective of treatment should be to lower BP to <140/190 mmHg in all patients and, provide that the treatment is well tolerated, treated BP values should be targeted to 130/80 mmHg or lower in most patients.

    · In patients<65 years it is recommended that SBP should be lowered to a BP range of 120-129 mmHg in most patients.
    BP treatment targets in older patients (65-80 years)BP Treatment targets in older patients (65-80 years)
    An SBP target of between 140-150 mmHg is recommended for older patients (65-80 years).In older patients (>65 years), it is recommended that SBP should be targeted to a BP range of 130-139 mmHG.
    BP treatment targets in patients aged over 80 years BP Treatment targets in patients aged over 80 years
    An SBP target between 140-150 mmHg should be considered in people older than 80 years with an initial SBP > 160 mmHg provided that they are in good physical and mental conditionAn SBP target range of 130-139 mmHg is recommended for people older than 80 years if tolerated.
    DBP targets DBP targets
    A DBP target of <90 mmHg is always recommended, except in patients with diabetes, in whom values <85 mmHg are recommendedA DBP target of <80 mmHg should be considered for all hypertensive patients, independent of the level of risk and comorbidities
    Initiation of drug treatmentInitiation of drug treatment
    Initiation of antihypertensive therapy with a two-drug combination may be considered in patients with markedly high baseline BP or at high CV risk.It is recommended to initiate an antihypertensive treatment with a two-drug combination, preferably in an SPC. The exceptions are trail older patients and those at low risk and with grade 1 hypertension (particularly if SBP is <150 mmHg)
    Resistant hypertension Resistant hypertension
    Mineral corticoid receptor antagonists, amiloride, and the alpha-1 blocker doxazosin should be considered if no contraindication exists.Recommended treatment of resistant hypertension is the addition of low-dose spironolactone to existing treatment, or the addition of further diuretic therapy if intolerant to spironolactone, with either eplerenone, amiloride, higher-dose thiazide/thiazide-like diuretic or a loop diuretic, or the addition of bisoprolol or doxazosin.
    Device-based therapy for hypertensionDevice-based therapy for hypertension
    In case of the ineffectiveness of drug treatment, invasive procedures such as renal denervation and baroreceptor stimulation may be consideredUse of device-based therapies is not recommended for the routine treatment of hypertension, unless in the context of clinical studies and RCTs, until further evidence regarding their safety and efficacy becomes available.

    Key Recommendations are :


    • It is now recommended that patients with low-moderate-risk grade 1 hypertension (office BP 140–159/90–99), even if they do not have HMOD, should now receive drug treatment if their BP is not controlled after a period of lifestyle intervention alone.

    • The new evidence suggests that lowering office SBP to <140 mmHg is beneficial for all patient groups, including independent older patients.

    • For diabetes, targeting the SBP to <140 mmHg and towards 130mmHg, is beneficial on major outcomes.

    • For patients with CKD, the evidence suggests that the target BP range should be 130–139mmHg.

    • The optimal DBP target of <80 mmHg is recommended in the new guidelines.

    • Always start treatment in most patients with two drugs, not one.

    • In women with hypertension with pregnancy, ACE inhibitors or ARBs and diuretics should be avoided, and the preferred medications to lower BP may include alpha-methyldopa, labetalol, or Calcium Channel Blockers.

    • Antiplatelet therapy like low-dose aspirin is recommended only for secondary prevention in hypertensive patients, not for primary prevention.


    For Further Reference log on to :

    https://drive.google.com/file/d/1-0jm_LL5sehhspGQEgP6HBFSZEjhr4Fj/view

    blood pressureBlood pressure measurementBPcombination therapyDevice therapy •Drug therapyESCEuropeanguidelineguidelinesHypertensionLatestLifestyle interventionsmediatedorgan damageSecondary hypertensiontargetstreatment thresholds
    Source : With inputs from European Society of Cardiology

    Disclaimer: This site is primarily intended for healthcare professionals. Any content/information on this website does not replace the advice of medical and/or health professionals and should not be construed as medical/diagnostic advice/endorsement or prescription. Use of this site is subject to our terms of use, privacy policy, advertisement policy. © 2020 Minerva Medical Treatment Pvt Ltd

    Dr. Kamal Kant Kohli Kohli
    Dr. Kamal Kant Kohli Kohli
      Show Full Article
      Next Story
      Similar Posts
      NO DATA FOUND

      • Email: info@medicaldialogues.in
      • Phone: 011 - 4372 0751

      Website Last Updated On : 12 Oct 2022 7:06 AM GMT
      Company
      • About Us
      • Contact Us
      • Our Team
      • Reach our Editor
      • Feedback
      • Submit Article
      Ads & Legal
      • Advertise
      • Advertise Policy
      • Terms and Conditions
      • Privacy Policy
      • Editorial Policy
      • Comments Policy
      • Disclamier
      Medical Dialogues is health news portal designed to update medical and healthcare professionals but does not limit/block other interested parties from accessing our general health content. The health content on Medical Dialogues and its subdomains is created and/or edited by our expert team, that includes doctors, healthcare researchers and scientific writers, who review all medical information to keep them in line with the latest evidence-based medical information and accepted health guidelines by established medical organisations of the world.

      Any content/information on this website does not replace the advice of medical and/or health professionals and should not be construed as medical/diagnostic advice/endorsement or prescription.Use of this site is subject to our terms of use, privacy policy, advertisement policy. You can check out disclaimers here. © 2025 Minerva Medical Treatment Pvt Ltd

      © 2025 - Medical Dialogues. All Rights Reserved.
      Powered By: Hocalwire
      X
      We use cookies for analytics, advertising and to improve our site. You agree to our use of cookies by continuing to use our site. To know more, see our Cookie Policy and Cookie Settings.Ok