2018 ESC/ESH Guidelines for the management of arterial hypertension1

The European Society of Cardiology (ESC) / European Society of Hypertension (ESH) 2018 guidelines on hypertension follow previous joint guidelines issued in 2003, 2007 and 20133. The 2018 guideline1 was refined, modified and expanded to incorporate new results published on the diagnosis and treatment of individuals with an elevated blood pressure1.

New definitions of hypertension are introduced. ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), Calcium channel blockers (CCBs) and (thiazide-) Diuretics are all suitable and recommended for the initiation and maintenance of antihypertensive treatment. Dual combination treatment (ACEi or ARB + CCB or diuretic) of these first-line agents are recommended for initial therapy.

The definition of hypertension have changed in Europe (ESC/ESH Guideline 20181) and also in the USA (ACC/AHA Guideline 20172). As both definitions differ, a comparison can be found in the following table:

Download ESC/ESH Guidelines

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

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).


          1. Williams B et al. European Heart Journal (2018) 39, 3021–3104
          2. Whelton PK et al. Hypertension (2018) 71, e13-e115
          3. Mancia G, et al. Eur Heart J. 2013;34(28):2159-219.