2013 European Hypertension Guidelines

Background and Purpose: Although much research has been published since these European guidelines were last revised in 2007, the authors state that arterial hypertension “remains a leading cause of death and cardiovascular morbidity.” This update provides important new recommendations for both primary-care and specialist providers.

1. Key Points:

A major development is the recommendation of a single systolic blood pressure (BP) target of 140 mm Hg for virtually all patients. This contrasts with the previously recommended targets of 140/90 mm Hg for moderate- and low-risk patients and 130/80 mm Hg for high-risk patients, which the present authors believe are not supported by current data.

2. Diagnosis and risk assessment. New recommendations include:

• An expanded role for home BP monitoring, ambulatory BP monitoring, or both as an adjunct to office-based BP measurement

• A greater emphasis on assessment of global cardiovascular risk

3. Treatment. The guidelines also provide new guidance with regard to antihypertensive drugs:

• No treatment in patients with high normal BP (Class III)

• No specific preferences of agents for single-drug or combination therapy

• An updated protocol for combination therapy focusing not on a hierarchy of medications, but rather on an individualized approach based on patients' comorbidities

• A particular focus on women during pregnancy with respect to preeclampsia and long-term hypertensive risk and management

• Specific guidance for managing hypertension in patients with diabetes, the young, and the elderly, including a strategy for drug treatment in octogenarians