GUIDELINES ON ARTERIAL HYPERTENSION MANAGEMENT OF THE EUROPEAN SOCIETY OF CARDIOLOGY AND EUROPEAN SOCIETY OF HYPERTENSION 2018: WHAT’S NEW?

Abstract

The article considers the key points of the new 2018 guidelines of the European Society of Cardiology and European Society of Hypertension on management and treatment of patients with arterial hypertension (AH). The guidelines widen the possibilities for ambulatory monitoring of blood pressure (BP) and at-home measurement of BP in diagnosis of AH, especially for detection of hidden (“masked”) hypertension and white-coat hypertension. New target ranges for BP depending on age and concomitant pathology are established. For most patients, BP <140 mm Hg (primary target) is accepted, for patients under 65 years if therapy is well-tolerated BP <130 mm Hg should be achieved. Selection of treatment for elderly patients shouldn’t be based on chronological age but on biological age taking into account evaluation of senile asthenia, self-maintenance and therapy tolerability. For starting selection of drugs for AH, in most patients two-component therapy (one pill drug) is preferable. The latest guidelines contain simplified algorithms for management of patients with AH. It is shown that in most patients, a preference should be made for combinations of renin-angiotensin-aldosterone system blocker (inhibitors of angiotensin-converting enzyme or angiotensin II receptor blockers) with a slow calcium channels blocker and/or thiazide/thiazide-like diuretic. Beta-blockers should be prescribed only for specific clinical cases. Special emphasis is made on evaluation of patient’s treatment adherence as the main reason for insufficient BP control, as well as on increased role of nurses and pharmacists in education, monitoring, and support of patients with AH being an important part of general strategy of BP control.

Keywords

• arterial hypertension
• target blood pressure values
• office blood pressure measurement
• outpatient blood pressure measurement
• white-coat hypertension
• ambulatory blood pressure monitoring
• risk factors
• target organ damage
• antihypertensive therapy
• combined therapy
• chronic kidney disease