First look at new 2018 joint ESH/ESC Guidelines on diagnosis and management of hypertension

Systemic hypertension (HTN) is the most prevalent non-communicable disease and the leading cause for major cardiovascular events, renal failure and cognitive decline. The World Health Organization showed that HTN is a key area of concern for healthcare and identified this condition as one of the primary targets for intervention to reduce global morbidity and mortality. The hard-hitting AHA/ACC Guidelines on management of High blood pressure in adults published in 2017 shocked medical community and enforced reconsidering overall significance HTN once again due to the large pool of newly diagnosed individuals and higher healthcare costs. Ensuing debates around Task Force committee opinions were fomenting at every scientific session related to cardiac diseases throughout first half-year 2018 and beyond the lecture halls as well. Thus all attendees at the 28th European Congress on Hypertension and Cardiovascular Protection held in Barcelona, Spain in June were captivated with the European expert’s presented preview of the new 2018 ESH/ESC joint clinical Guidelines on diagnosis and management of HTN. This short review highlights the bullet points presented before fulltext publication. The chapters on diagnosis, risk stratification, blood pressure treatment target ranges had undergone minor but crucial corrections. Key changes include medical treatment of uncomplicated HTN and drug therapy in special groups with major comorbidities, management of resistant HTN, device-based HTN therapy and adherence interventions. 

1. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, AdairRohani HA et al. Сomparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2224–2260. doi: 10.1016/S0140-6736(12)61766-8

2. Ettehad D, Connor AE, Kiran A, Anderson SG, Callender T, Emberson J et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and metaanalysis. Lancet. 2016;387(10022):957–967. doi:10.1016/S0140–6736(15)01225-8

3. Olsen MH, Angell SY, Asma S, Boutouyrie P, Burger D, Chirinos JA. A call to action and a lifecourse strategy to address the global burden of raised blood pressure on current and future generations: the Lancet Commission on hypertension. Lancet. 2016; 388(10060);2665–2712. doi:10.1016/S0140-6736(16)31134-5

4. Foy AJ, Mandrola JM. Heavy Heart: The economic burden of heart disease in the United States Now and in the future. Prim Care. 2018;45(1):17–24. doi:10.1016/j.pop.2017.11.002

5. [Электронный ресурс]. URL: http://www.who.int/health_financing/topics/resource-tracking/ghed-update/en/

6. [Электронный ресурс]. URL: https://www.minfin.ru/common/upload/library/2017/10/main/ buklet_inet_130x300.pdf [In Russian]

7. Redon J, Mourad JJ, Schmieder RE, Volpe M, Weiss TW. Why in 2016 are patients with hypertension not 100% controlled? A call to action. J Hypertens. 2016;34(8):1480–1488. doi:10.1097/HJH.0000000000000988

8. Yoon SS, Carroll MD, Fryar CD. Hypertension prevalence and control among adults: United States, 2011–2014. NCHS Data Brief. 2015;220:1–8.

9. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C et al.2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):1269–1324. doi:10.1161/HYP.0000000000000066

10. Whelton PK. The elusiveness of population-wide high blood pressure control. Annu Rev Public Health. 2015;36:109–130. doi:10.1146/annurev-publhealth031914-122949.

11. [Электронный ресурс]. URL: http://www.eshonline.org/esh-annual-meeting/

12. SPRINT Research Group, Wright JT, Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373(22):2103–2116. doi:10.1056/NEJMoa1511939

13. Johnson KC, Whelton PK, Cushman WC, Cutler JA, Evans GW, Snyder JK. Blood pressure measurement in SPRINT (Systolic Blood Pressure Intervention Trial). Hypertension. 2018;71 (5):848–857. doi:10.1161/HYPERTENSIONAHA.117.10479

14. Leung AA, Daskalopoulou SS, Dasgupta K, McBrien K, Butalia S, Zarnke KB et al. Hypertension Canada’s 2017 Guidelines for diagnosis, risk assessment, prevention, and treatment of hypertension in adults. Canadian Journal of Cardiology. 2017;33 (5):557–576. doi:10.1016/j.cjca.2017.03.005

15. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34 (28):2159–2219. doi:10.1093/eurheartj/eht151

16. Piepoli MF, Hoes AW, Agewall F, Albus C, Brotons C, Catapano AL et al. 2016 European guidelines on cardiovascular disease prevention in clinical practice: the Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (Constituted by Representatives of 10 Societies and by Invited Experts): Developed with the Special Contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur J Prevent Cardiol. 2016;23(11): NP1 NP96. doi:10.1177/2047487316653709

17. Choi HJ. Blood pressure variability and its management in hypertensive patients. Korean J Fam Med. 2012;33(6):330–335. doi:10.4082/kjfm.2012.33.6.330

18. Brunström M, Carlberg B. Effect of antihypertensive treatment at different blood pressure levelsin patients with diabetes mellitus: systematic review and meta-analyses. Br Med J. 2016;352: i717. doi:10.1136/bmj.i717

19. Lindholm LH, Carlberg B, Samuelsson O. Should beta blockers remain first choice in the treatment of primary hypertension? A meta-analysis. Lancet. 2005;366(9496):1545–1553. doi:10.1016/S0140–6736(05)67573-3

20. Kjeldsen SE, Messerli FH, Chiang CE, Meredith PA, Liu L. Are fixed-dose combination antihypertensives suitable as first-line therapy? Curr Med Res Opin. 2012;28(10):1685–1697. doi:10.1185/03007995.2012.729505

21. MacDonald TM, Williams B, Webb DJ, Morant S, Caulfield M, Cruickshank JK et al. Combination therapy is superior to sequential monotherapy for the initial treatment of hypertension: a doubleblind randomized controlled trial. J Am Heart Association. 2017;6: e006986. doi:10.1161/JAHA.117.006986

22. Piepoli MF, Hoes AW, Agewall F, Albus C, Brotons C, Catapano AL et al. 2016 European guidelines on cardiovascular disease prevention in clinical practice: the Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (Constituted by Representatives of 10 Societies and by Invited Experts): Developed with the Special Contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur J Prevent Cardiol. 2016;23(11):1–96. doi:10.1177/2047487316653709

23. Wei FF, Zhang ZY, Huang QF, Staessen JA. Diagnosis and management of resistant hypertension: state of the art. Nat Rev Nephrol 2018;14(7):428–441. doi:10.1038/s41581-018-0006-6

24. Williams B, MacDonald TM, Morant S, Webb DJ, Sever P, McInnes G et al. Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY 2): a randomised, double-blind, crossover trial. Lancet. 2015;386 (10008):2059–2068. doi:10.1016/S0140-6736(15)00257-3

25. Esler M. Renal denervation for treatment of drug-resistant hypertension. Trends Cardiovasc Med. 2015;25(2):107–115. doi:10.1016/j.tcm.2014.09.014