2018 ESC/ESH Guidelines for the management of arterial hypertension

          A first look at the new ‘Guidelines for the management of arterial hypertension’ by the European Society of Cardiology (ESC) / European Society of Hypertension (ESH) has been presented recently in Barcelona. Following the presentation during the ‘28th European Meeting on Hypertension and Cardiovascular Protection’ on June 9th 2018, we had the chance to interview two very well-known Investigators, Prof. Dr. Sverre E. Kjeldsen, MD, FAHA, FESC (Professor of Cardiology / former President of European Society of Hypertension) and Professor Dr. Gianfranco Parati MD, FESC (Professor of Cardiovascular Medicine / Secretary General of World Hypertension League), on the impact and highlights of the new Guideline.

          The full text of the new joint guidelines will be published on August 25th 2018 in parallel with a corresponding presentation during the ESC Congress 2018 in Munich (August 25-29, 2018).

          2013 ESC/ESH Guidelines for the management of arterial hypertension

          The European Society of Hypertension (ESH) / European Society of Cardiology (ESC) 2013 guidelines on hypertension follow previous joint guidelines issued in 2003 and 20071. The 2013 guideline was refined, modified and expanded to incorporate new results published on the diagnosis and treatment of individuals with an elevated blood pressure1.
          Diuretics, beta-blockers, calcium channel blockers, ACE inhibitors (ACEIs), and angiotensin receptor blockers (ARBs) are all suitable and recommended for the initiation and maintenance of antihypertensive treatment, either as monotherapy or in some combinations with each other.
          Class I recommendation.
          Level of evidence A.
          Possible combinations of classes of antihypertensive drugs

          Green continuous lines: preferred combinations.

          Green dashed line: useful combination (with some limitations).

          Black dashed lines: possible but less well-tested combinations.

          Red continuous line: not recommended combination.

          Use of CCBs

          Observations on the use of CCBs

          • Dihydropyridine CCBs are the only antihypertensive drug class that do not have any compelling evidence for a contraindication to use1
          • CCBs and renin-angiotensin system (RAS) blockers are preferred choices in hypertensive patients with metabolic syndrome1
          • CCBs can be used in combination with all other antihypertensive drug classes, with thiazide diuretics, ARBs and ACEIs1

          Contraindications for CCBs

          CCBs: no compelling evidence for a contraindication to use1

          References

          1. Mancia G, et al. Eur Heart J. 2013;34(28):2159-219.

          Homepage references

          1. Mancia G, et al. Eur Heart J. 2013;34(28):2159-219.
          2. James PA, et al. JAMA. doi:10.1001/jama.2013.284427. Published online December 18, 2013.
          3. Flack JM, et al. Hypertension 2010;56:780-800. Available at: http://goo.gl/o85pwp. Accessed 2 February 2018.
          4. Canadian Hypertension Education Programm [Internet]. Available from: http://goo.gl/j8oACH. Accessed 15th February 2018.
          5. Liu LS, et al. Zhonghua Xin Xue Guan Bing Za Zhi. 2011;39:579-615.
          6. Park JB. Korean Circulation J. 2006;36:405-10. Available from: http://goo.gl/pRNwFX. Accessed 2 February 2018.
          7. Chiang CE, et al. J Formas Med Assoc. 2010;109:740-73. Available from: http://goo.gl/PdRFqe. Accessed 2 February 2018.