HYPERTENSION GUIDELINES 2023
- The 2023 European Society of Hypertension (ESH) and 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guidelines both emphasize proper blood pressure (BP) measurement, cardiovascular (CV) risk assessment, optimal lifestyle interventions, and specific pharmacotherapy management.
- Both guidelines recommend a lower BP target (<130/80 mm Hg) for adults at high risk to reduce the risk of CV events.
- Key differences include a lower diagnostic threshold by ACC/AHA criteria (<130/80 mm Hg) than by ESH criteria (<140/90 mm Hg) and age-based treatment targets (ESH criteria).
- Both guidelines stress the importance of standardized, accurate measurement of blood pressure (BP) and recommend office-based measurements for diagnosis.
- 2023 ESH guidelines emphasize using out-of-office BP monitoring in addition to traditional in-office measurements to diagnose hypertension.
- The ESH guidelines recommend using the updated Systematic Coronary Risk Evaluation 2 (SCORE2) tool for CVD risk stratification. The SCORE2 tool estimates 10-year risk of both fatal and nonfatal CVD events in adults 40-69 years of age
- Blood Pressure Categories and Hypertension Diagnosis-
- Blood Pressure Treatment Targets – The ACC/AHA guideline recommends treatment to a BP target of <130/80 mm Hg for many patients. The ESH guidelines target BP <140/80 mm Hg for patients 65-79 years of age.
- Recommendations for Drug Therapy Initiation – Promotion of lifestyle interventions to prevent, treat, and delay onset of hypertension feature prominently in both guidelines.2,3Both guidelines recommend treatment initiation with antihypertensive agents for patients who have established CVD and BP ≥130/80 mm Hg.
- Pharmacotherapy – Initial therapies include at least one of four major classes: angiotensin-converting enzyme inhibitors (ACEIs), angiotensin-receptor blockers (ARBs), thiazide or thiazide-like diuretics, and calcium channel blockers (CCBs). The ESH guidelines continue to include beta-blockers (BBs) as an optional first-line therapy. Both guidelines recommend single-pill combination therapy to reduce pill burden and improve adherence. The ESH guidelines recommend the preferred combination of ACEIs or ARBs with either CCBs or thiazide/thiazide-like diuretics. Whereas the ESH guidelines strongly emphasize initial treatment with a two-drug combination for most patients with hypertension.
- Renal Denervation Therapy – The updated ESH guidelines now recommend consideration of renal denervation therapy as an additional or alternative therapy in patients who have uncontrolled resistant hypertension or adverse effects to medications, which is a change from the 2018 ESC/ESH guidelines.
…….. Complied by Dr. Arvind Ghongane