2018 ESC-ESH Guidelines for the Management of Arterial Hypertension (Summary)

In this article, we will discuss 2018 ESC-ESH Guidelines for the Management of Arterial Hypertension (Summary). So, let’s get started.

Summary of the Guidelines

(1) BP targets for treatment

– (a) <140/90 in the general hypertensive population regardless of the CV risk
– (b) If treatment is well tolerated target <130/80 mm Hg but not lower than 120 mm Hg and
DBP not lower than 70 mm Hg.

(2) Evidence in favor of lower BP target is less strong in hypertensive subgroups — older/diabetes/CKD/CAD

– (a) Age – <65 years 120 to <130 mm Hg
– (b) Age – >65 years 130 to <140 mm Hg
– (c) Diabetes – 130 mm Hg or lower if tolerated
– (d) CAD – 130 mm Hg or lower
– (e) CKD – 130 to < 140 mm Hg
– (f) Post-stroke/TIA – 120 to <130 mm Hg

(3) Life style recommendations

– (a) Salt intake <5 g/day (from the previous 5-6 g/day)
– (b) Alcohol intake <14 units/week for men and <8 units/week for women
– (c) Regular aerobic exercise – 30 min, 5-7 days per week

(4) Recommendations for management

– (a) Combination treatment for most patients as initial therapy – ACEI/ARB+CCB/Diuretic.
– (b) Initiation with fixed dose combination preferred in most patients except in the elderly and low risk Grade I hypertension.
– (c) Beta-blockers in combination with other agents in specific conditions, like angina, MI, HF
– (d) 3 Drug combination of ACEI/ARB+CCB+Diuretic, if BP not controlled with 2 drug combination
– (e) If BP not controlled with 3 drug combination, add spironolactone to existing treatment
– (f) In patients with CKD/ CAD initial dual combination therapy recommended. In CKD patients, diureties to be replaced with loop diuretics.
– (g) In resistant hypertension, add low doses of spironolactone to existing treatment.

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