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2                                                                                      ESC/ESH Guidelines



          Document Reviewers: Guy De Backer (ESC Review Co-ordinator) (Belgium), Anthony M. Heagerty (ESH
          Review Co-ordinator) (UK), Stefan Agewall (Norway), Murielle Bochud (Switzerland), Claudio Borghi
          (Italy), Pierre Boutouyrie (France), Jana Brguljan (Slovenia), He´ctor Bueno (Spain), Enrico G. Caiani (Italy),
          Bo Carlberg (Sweden), Neil Chapman (UK), Renata C ıfkov a (Czech Republic), John G. F. Cleland (UK),
          Jean-Philippe Collet (France), Ioan Mircea Coman (Romania), Peter W. de Leeuw (The Netherlands),
          Victoria Delgado (The Netherlands), Paul Dendale (Belgium), Hans-Christoph Diener (Germany),
          Maria Dorobantu (Romania), Robert Fagard (Belgium), Csaba Farsang (Hungary), Marc Ferrini (France),
          Ian M. Graham (Ireland), Guido Grassi (Italy), Hermann Haller (Germany), F. D. Richard Hobbs (UK),
          Bojan Jelakovic (Croatia), Catriona Jennings (UK), Hugo A. Katus (Germany), Abraham A. Kroon
          (The Netherlands), Christophe Leclercq (France), Dragan Lovic (Serbia), Empar Lurbe (Spain),
          Athanasios J. Manolis (Greece), Theresa A. McDonagh (UK), Franz Messerli (Switzerland), Maria Lorenza
          Muiesan (Italy), Uwe Nixdorff (Germany), Michael Hecht Olsen (Denmark), Gianfranco Parati (Italy),
          Joep Perk (Sweden), Massimo Francesco Piepoli (Italy), Jorge Polonia (Portugal), Piotr Ponikowski
          (Poland), Dimitrios J. Richter (Greece), Stefano F. Rimoldi (Switzerland), Marco Roffi (Switzerland),
          Naveed Sattar (UK), Petar M. Seferovic (Serbia), Iain A. Simpson (UK), Miguel Sousa-Uva (Portugal),
          Alice V. Stanton (Ireland), Philippe van de Borne (Belgium), Panos Vardas (Greece), Massimo Volpe (Italy),
          Sven Wassmann (Germany), Stephan Windecker (Switzerland), Jose Luis Zamorano (Spain)
          The disclosure forms of all experts involved in the development of these Guidelines are available on the
          ESC website www.escardio.org/guidelines






          ...................................................................................................................................................................................................
          Keywords        Guidelines • Hypertension • Blood pressure • Blood pressure measurement • Blood pressure treatment
                          thresholds and targets • Hypertension-mediated organ damage • Lifestyle interventions • Drug therapy •
                          Combination therapy • Device therapy • Secondary hypertension




                                                            . .
          Table of Contents                                 . .  4.6 Advantages and disadvantages of ambulatory blood pressure
                                                            . . .  monitoring and home blood pressure monitoring . . . . . . . . . . . . . . . . . .17
          1 Preamble ... .. ... ... .. ... .. ... ... .. ... .. ... ... .. ... .. ... ... .. ... .. . 5  . . .  4.7 White-coat hypertension and masked hypertension . . . . . . . . . . . .17
          2 Introduction . . ... ... .. ... .. ... ... .. ... .. ... ... .. ... .. ... ... .. ... .. . 5  . . .  4.7.1 White-coat hypertension . ... ... .. ... .. ... ... .. ... .. ... .17
           2.1 What is new and what has changed in the 2018 European  . . .  4.7.2 Masked hypertension ... .. ... ... .. ... .. ... ... .. ... .. ... .18
           Society of Cardiology/European Society of Hypertension  . . .  4.8 Screening for the detection of hypertension . .. ... ... .. ... .. ... .18
           arterial hypertension Guidelines? . .. ... .. ... ... .. ... .. ... ... .. ... .. . 7  . . .  4.9 Confirming the diagnosis of hypertension. ... .. ... ... .. ... .. ... .18
          3 Definition, classification, and epidemiological aspects  . . . .  4.10 Clinical indications for out-of-office blood
          of hypertension . ... ... .. ... .. ... ... .. ... .. ... ... .. ... .. ... ... .. ... ..10  . . .  pressure measurements. .. ... .. ... .. ... ... .. ... .. ... ... .. ... .. ... .18
           3.1 Definition of hypertension. ... .. ... .. ... ... .. ... .. ... ... .. ... ..10  . . .  4.11 Blood pressure during exercise and at high altitude . . . . . . . . . . . .20
           3.2 Classification of blood pressure . ... .. ... ... .. ... .. ... ... .. ... ..10  . . .  4.12 Central aorticpressure. . . . ... .. ... ... .. ... .. ... ... .. ... .. ... .20
           3.3 Prevalence of hypertension ... .. ... .. ... ... .. ... .. ... ... .. ... ..10  . . .  5 Clinical evaluation and assessment of hypertension-mediated
           3.4 Blood pressure relationship with risk of cardiovascular and  . . .  organ damage in patients with hypertension . . . . ... .. ... ... .. ... .. ... .21
           renal events . . ... ... .. ... .. ... ... .. ... .. ... ... .. ... .. ... ... .. ... ..12  . . .  5.1 Clinical evaluation . . ... ... .. ... .. ... ... .. ... .. ... ... .. ... .. ... .21
           3.5 Hypertension and total cardiovascular risk assessment . . . . . . . . . .12  . . .  5.2 Medical history... .. ... ... .. ... .. ... ... .. ... .. ... ... .. ... .. ... .21
           3.6 Importance of hypertension-mediated organ damage in  . . .  5.3 Physical examination and clinical investigations. . . . . . . . . . . . . . . . . .22
           refining cardiovascular risk assessment in hypertensive patients . . . . .13  . . .  5.4 Assessment of hypertension-mediated organ damage . . . . . . . . . . .22
           3.7 Challenges in cardiovascular risk assessment. . . . . . . . . . . . . . . . . . . .14  . . .  5.4.1 Using hypertension-mediated organ damage to help
          4 Blood pressure measurement. . ... .. ... .. ... ... .. ... .. ... ... .. ... ..15  . . .  stratify risk in hypertensive patients... .. ... .. ... ... .. ... .. ... .22
           4.1 Conventional office blood pressure measurement . . . . . . . . . . . . . .15  . . .  5.5 Characteristics of hypertension-mediated organ damage . . . . . . . .24
           4.2 Unattended office blood pressure measurement. . . . . . . . . . . . . . . .15  . . .  5.5.1 The heart in hypertension. ... ... .. ... .. ... ... .. ... .. ... .24
           4.3 Out-of-office blood pressure measurement . . . . . . . . . . . . . . . . . . . .16  . . .  5.5.2 The blood vessels in hypertension. . . . . . . . . . . . . . . . . . . . . . .24
           4.4 Home blood pressure monitoring. . .. ... ... .. ... .. ... ... .. ... ..16  . . .  5.5.3 The kidney in hypertension .. ... .. ... .. ... ... .. ... .. ... .25
           4.5 Ambulatoryblood pressure monitoring . ... .. ... .. ... ... .. ... ..16  . . .  5.5.4 Hypertensive retinopathy. ... ... .. ... .. ... ... .. ... .. ... .25




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