What are the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) guidelines for the management of hypertension (high blood pressure)?

Updated: Feb 22, 2019
  • Author: Matthew R Alexander, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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Answer

In June 2013, the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) released new guidelines for the management of hypertension, recommending that all patients, except special populations such as patients with diabetes and the elderly, be treated to below 140 mm Hg systolic BP. [125, 126]  The guidelines advise that physicians should make decisions on treatment strategies based on the patient's overall level of cardiovascular risk.

Recommendations of the new ESH and ESC guidelines include [125, 126] :

  • In patients younger than 80 years, the systolic BP target should be 140 to 150 mm Hg, but physicians can go lower than 140 mm Hg if the patient is fit and healthy; the same advice applies to octogenarians—however, the patient's mental capacity and physical heath should also be considered if targeting to less than 140 mm Hg

  • Patients with diabetes should be treated to below 85 mm Hg diastolic BP

  • Salt intake should be limited to approximately 5 to 6 g per day

  • Body-mass index (BMI) should be reduced to 25 kg/m2 and waist circumferences should be reduced to less than 102 cm in men and less than 88 cm in women

  • Ambulatory BP monitoring (ABPM) should be incorporated into the assessment of risk

  • Effective combination therapies include thiazide diuretics with ARBs, calcium-channel antagonists, or ACEIs; or, calcium-channel antagonists with ARBs or ACEIs

  • Dual renin-angiotensin system blockade (ie, ARBs, ACEIs, and direct renin inhibitors) is not recommended because of the risks of hyperkalemia, low BP, and kidney failure


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