Page 31 - GUIAS ESC ESH 2018

ESC/ESH Guidelines 31

Initiation of hypertension treatment according to office BP

Recommendations Class a Level b
Prompt initiation of BP-lowering drug treatment is recommended in patients with grade 2 or 3 hypertension at any level of CV
I A
risk, simultaneous with the initiation of lifestyle changes. 2,8
In patients with grade 1 hypertension:
II B
Lifestyle interventions are recommended to determine if this will normalize BP. 219
In patients with grade 1 hypertension at low–moderate-risk and without evidence of HMOD, BP-lowering drug treatment is
I A
recommended if the patient remains hypertensive after a period of lifestyle intervention. 211,212
In patients with grade 1 hypertension and at high risk or with evidence of HMOD, prompt initiation of drug treatment is rec-
I A
211,212
ommended simultaneously with lifestyle interventions.
In fit older patients with hypertension (even if aged >80 years), BP-lowering drug treatment and lifestyle intervention are rec-
I A
ommended when SBP is >_160 mmHg. 210,220,221
BP-lowering drug treatment and lifestyle intervention are recommended for fit older patients (>65 years but not >80 years)
I A
when SBP is in the grade 1 range (140–159 mmHg), provided that treatment is well tolerated. 212
Antihypertensive treatment may also be considered in frail older patients if tolerated. 215 IIb B

Withdrawal of BP-lowering drug treatment on the basis of age, even when patients attain an age of >_80 years, is not recom-
III A
mended, provided that treatment is well tolerated. 213
In patients with high–normal BP (130–139/85–89 mmHg): I A
Lifestyle changes are recommended. 17,35
Drug treatment may be considered when their CV is very high due to established CVD, especially CAD. 217 IIb A

BP = blood pressure; CAD = coronary artery disease; CV = cardiovascular; CVD = cardiovascular disease; HMOD = hypertension-mediated organ damage; SBP = systolic
blood pressure.
a
Class of recommendation.
b
Level of evidence.
c
In patients with grade 1 hypertension and at low–moderate-risk, drug treatment may be preceded by a prolonged period of lifestyle intervention to determine if this approach
will normalize BP. The duration of the lifestyle intervention alone will depend on the level of BP within the grade 1 range, i.e. the likelihood of achieving BP control with lifestyle
intervention alone, and the opportunities for significant lifestyle change in individual patients.

Table 19 Summary of office blood pressure thresholds for treatment

Age group Office SBP treatment threshold (mmHg) Office DBP treatment
threshold (mmHg)
Hypertension 1 Diabetes 1 CKD 1 CAD 1 Stroke/TIA
18 - 65 years >_140 >_140 >_140 >_140 a >_140 a >_90

65 - 79 years >_140 >_140 >_140 >_140 a >_140 a >_90
>_80 years >_160 >_160 >_160 >_160 >_160 >_90
Office DBP treatment >_90 >_90 >_90 >_90 >_90
threshold (mmHg)

BP = blood pressure; CAD = coronary artery disease; CKD = chronic kidney disease; DBP = diastolic blood pressure; SBP = systolic blood pressure; TIA = transient
ischaemic attack.
a
Treatment may be considered in these very high-risk patients with high–normal SBP (i.e. SBP 130–140 mmHg).

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