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ESC/ESH Guidelines 7
2.1 What is new and what has changed in the 2018 ESC/ESH Arterial Hypertension
Guidelines?
Changes in recommendations
2013 2018
Diagnosis Diagnosis
Office BP is recommended for screening and diagnosis of It is recommended to base the diagnosis of hypertension on:
hypertension. • Repeated office BP measurements; or
• Out-of-office BP measurement with ABPM and/or HBPM if logistically
and economically feasible.
Treatment thresholds Treatment thresholds
Highnormal BP (130–139/85–89 mmHg): Unless the necessary Highnormal BP (130–139/85–89 mmHg): Drug treatment may be
evidence is obtained, it is not recommended to initiate considered when CV risk is very high due to established CVD, especially
antihypertensive drug therapy at high–normal BP. CAD.
Treatment thresholds Treatment thresholds
Treatment of low-risk grade 1 hypertension: Treatment of low-risk grade 1 hypertension:
Initiation of antihypertensive drug treatment should also be In patients with grade 1 hypertension at low–moderate-risk and without
considered in grade 1 hypertensive patients at low–moderate-risk, evidence of HMOD, BP-lowering drug treatment is recommended if the
when BP is within this range at several repeated visits or elevated by patient remains hypertensive after a period of lifestyle intervention.
ambulatory BP criteria, and remains within this range despite a
reasonable period of time with lifestyle measures.
Treatment thresholds Treatment thresholds
Older patients Older patients
Antihypertensive drug treatment may be considered in the elderly BP-lowering drug treatment and lifestyle intervention is recommended in
(at least when younger than 80 years) when SBP is in the fit older patients (>65 years but not >80 years) when SBP is in the
140–159 mmHg range, provided that antihypertensive treatment is grade 1 range (140–159 mmHg), provided that treatment is well tolerated.
well tolerated.
BP treatment targets BP treatment targets
An SBP goal of <140 mmHg is recommended. • It is recommended that the first objective of treatment should be to
lower BP to <140/90 mmHg in all patients and, provided that the
treatment is well tolerated, treated BP values should be targeted to
130/80 mmHg or lower in most patients.
• In patients <65 years it is recommended that SBP should be lowered
to a BP range of 120–129 mmHg in most patients.
Continued
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