COMMENTARY

Hypertension Highlights: Updates for European Guidelines, Plus New Evidence for Blood Pressure Targets and Strategies

Linda Brookes, MSc

Disclosures

October 12, 2009

In This Article

Overview: Hypertension Highlights

This month's Hypertension Highlights begins with a discussion of the guideline update from the European Society of Hypertension (ESH) published in October 2009. The update incorporates new evidence from studies completed since the last hypertension guidelines were published in 2007. The new evidence-based recommendations will be especially important because 2 recent reviews of antihypertensive treatment strategies, also discussed in detail in this month's Hypertension Highlights, have found conflicting results. The first review, exclusive of data from randomized controlled clinical trials (RCTs), found there is no evidence that lowering blood pressure to systolic blood pressure/diastolic blood pressure (SBP/DBP) targets ≤ 140-160/90-100 mm Hg reduces morbidity and mortality in hypertensive patients. Conversely, the Cardio-Sis study found that tight control of SBP to < 130 mm Hg in nondiabetic patients with apparently treatment-resistant systolic hypertension and at least 1 additional risk factor reduced the incidence of prespecified cardiovascular outcomes after 2 years compared with usual control.

For diabetic patients, in advance of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial's hypertension results, further analysis of data from the Action in Diabetes and Vascular Disease: PreterAx and DiamicroN MR Controlled Evaluation (ADVANCE) trial has shown that in patients with type 2 diabetes mellitus who also have hypertension or microalbuminuria, the combined effect of blood pressure lowering and intensive glucose control was at least as great as the effect of either treatment alone for all clinical outcomes, and appeared to have a greater effect in some.

Then, in contradistinction to the guidelines from the Kidney Disease Outcomes Quality Initiative (K/DOQI), which did not recommend any specific drug class as first choice in hypertensive kidney transplant recipients, a new meta-analysis has found that calcium channel blockers (CCBs) should be the first-line drug class of choice.

Finally, in nonobese patients (body mass index [BMI] < 30.0 kg/m2), prehypertension (SBP 120-129 mm Hg or DBP 80-89 mm Hg) is not associated with increased risk for chronic or end-stage kidney disease, although the risk increases “"substantially" for prehypertensive patients with BMI > 30 kg/m2.

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