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Summary of the 2007 European Society of Hypertension (ESH) and European Society of Cardiology (ESC) guidelines for the management of arterial hypertension.

- Vasc Health Risk Manag (2007)

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The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) published their first European-specific guidelines in 2003... This more holistic approach recognizes that the majority of patients with high BP exhibit additional CV risk factors, and the potentiation of concomitant BP and metabolic risk factors leads to a CV risk that is more than the sum of the individual components... The total CV risk should be used to grade intensity of therapeutic approach and guide decisions on treatment strategies, including: Initiation of drug treatment BP threshold and target Use of combination treatment or additional non-antihypertensive agents Cost-effectiveness... BP targets are (systolic/diastolic): ≤140/90 mmHg in all patients with hypertension ≤130/80 mmHg in patients with diabetes and in high-risk, or very high-risk, patients (eg, those with associated clinical conditions such as stroke, MI, renal dysfunction, proteinuria)... With a view to offering guidance on appropriate targets and treatment in less standard situations, the Guidelines discuss therapeutic approaches in special conditions... RCTs have shown that older patients (≥60 years) benefit from antihypertensive drug treatment in terms of reduced CV morbidity and mortality... For patients with cerebrovascular disease, a treatment goal of BP <130/80 mmHg is recommended and pharmacological interventions should be initiated when BP is in the high-normal range... Evidence suggests the benefit of antihypertension in this patient group is afforded by BP reduction... Patients with coronary heart disease (CHD) often have a history of hypertension and the risk of a fatal or non-fatal coronary event post MI is greater if BP is elevated... The Guidelines recommend post-MI administration of BB, ACEI or ARBs, which have been shown to reduce the incidence of recurrent MI and death largely because of direct organ protective properties of the agents, but may be supported by the associated reduction in BP as a result of these agents... In permanent AF, BB and non-dihydropiridine CA remain important classes of drugs for the control of ventricular rate... Both genders respond to antihypertensive agents and benefit from the effects of lowering BP, but there are additional considerations that should be taken into account when prescribing for women... Low-dose aspirin should also be considered in patients with hypertension who are ≥50 years old, even in those without a history of CVD, if they have a moderate increase in serum creatinine or high CV risk... In all these conditions, the benefit-to-risk ratio (weighed as a reduction of MI risk against bleeding) has been proven favorable... Frequency of visits can be reduced considerably once target BP and other treatment goals have been achieved, eg, every 6 months for patients with low additional CV risks, but more frequently where there are concomitant risk factors.

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Stratification of CV risk into four categories.Low, moderate, high and very high risk refer to 10-year risk of a CV fatal or non-fatal event. The term “added” indicates that in all categories risk is greater than average. The dashed line indicates how definition of hypertension may be variable, depending on the level of total CV risk.Abbreviations: DBP, diastolic blood pressure; CV, cardiovascular; HT, hypertension; MS, metabolic syndrome; OD, subclinical organ damage; SBP, systolic blood pressure.
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fig1: Stratification of CV risk into four categories.Low, moderate, high and very high risk refer to 10-year risk of a CV fatal or non-fatal event. The term “added” indicates that in all categories risk is greater than average. The dashed line indicates how definition of hypertension may be variable, depending on the level of total CV risk.Abbreviations: DBP, diastolic blood pressure; CV, cardiovascular; HT, hypertension; MS, metabolic syndrome; OD, subclinical organ damage; SBP, systolic blood pressure.

Mentions: For practical reasons, including their intrinsic use in key RCTs, classification of hypertension and risk assessment should be based on systolic and diastolic BP. However, the Guidelines also recognize that pulse pressure may be a useful parameter to identify systolic hypertension in elderly patients who may be at particularly high risk (Blacher et al 2000; Gasowski et al 2002; Laurent 2006). The Guidelines define optimal BP as <120 (systolic) and <80 (diastolic), and normal BP as 120–129 (systolic) and/or 80–84 (diastolic). Figure 1 illustrates the classification of hypertension, as retained from the 2003 ESH/ESC Guidelines, with recognition that the threshold for hypertension should be regarded as flexible; being higher or lower based on the total CV risk of each individual. It is of note, however, that if a patient’s systolic and diastolic pressures lie in different categories, the risk relating to the higher category should be attributed to the patient. Furthermore, low diastolic BP (eg, 60–70 mmHg) should be regarded as an additional risk. Isolated systolic hypertension does not appear in Figure 1 but is defined in the Guidelines as ≥140 (systolic) and <90 (diastolic).


Summary of the 2007 European Society of Hypertension (ESH) and European Society of Cardiology (ESC) guidelines for the management of arterial hypertension.

- Vasc Health Risk Manag (2007)

Stratification of CV risk into four categories.Low, moderate, high and very high risk refer to 10-year risk of a CV fatal or non-fatal event. The term “added” indicates that in all categories risk is greater than average. The dashed line indicates how definition of hypertension may be variable, depending on the level of total CV risk.Abbreviations: DBP, diastolic blood pressure; CV, cardiovascular; HT, hypertension; MS, metabolic syndrome; OD, subclinical organ damage; SBP, systolic blood pressure.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2350144&req=5

fig1: Stratification of CV risk into four categories.Low, moderate, high and very high risk refer to 10-year risk of a CV fatal or non-fatal event. The term “added” indicates that in all categories risk is greater than average. The dashed line indicates how definition of hypertension may be variable, depending on the level of total CV risk.Abbreviations: DBP, diastolic blood pressure; CV, cardiovascular; HT, hypertension; MS, metabolic syndrome; OD, subclinical organ damage; SBP, systolic blood pressure.
Mentions: For practical reasons, including their intrinsic use in key RCTs, classification of hypertension and risk assessment should be based on systolic and diastolic BP. However, the Guidelines also recognize that pulse pressure may be a useful parameter to identify systolic hypertension in elderly patients who may be at particularly high risk (Blacher et al 2000; Gasowski et al 2002; Laurent 2006). The Guidelines define optimal BP as <120 (systolic) and <80 (diastolic), and normal BP as 120–129 (systolic) and/or 80–84 (diastolic). Figure 1 illustrates the classification of hypertension, as retained from the 2003 ESH/ESC Guidelines, with recognition that the threshold for hypertension should be regarded as flexible; being higher or lower based on the total CV risk of each individual. It is of note, however, that if a patient’s systolic and diastolic pressures lie in different categories, the risk relating to the higher category should be attributed to the patient. Furthermore, low diastolic BP (eg, 60–70 mmHg) should be regarded as an additional risk. Isolated systolic hypertension does not appear in Figure 1 but is defined in the Guidelines as ≥140 (systolic) and <90 (diastolic).

View Article: PubMed Central - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) published their first European-specific guidelines in 2003... This more holistic approach recognizes that the majority of patients with high BP exhibit additional CV risk factors, and the potentiation of concomitant BP and metabolic risk factors leads to a CV risk that is more than the sum of the individual components... The total CV risk should be used to grade intensity of therapeutic approach and guide decisions on treatment strategies, including: Initiation of drug treatment BP threshold and target Use of combination treatment or additional non-antihypertensive agents Cost-effectiveness... BP targets are (systolic/diastolic): ≤140/90 mmHg in all patients with hypertension ≤130/80 mmHg in patients with diabetes and in high-risk, or very high-risk, patients (eg, those with associated clinical conditions such as stroke, MI, renal dysfunction, proteinuria)... With a view to offering guidance on appropriate targets and treatment in less standard situations, the Guidelines discuss therapeutic approaches in special conditions... RCTs have shown that older patients (≥60 years) benefit from antihypertensive drug treatment in terms of reduced CV morbidity and mortality... For patients with cerebrovascular disease, a treatment goal of BP <130/80 mmHg is recommended and pharmacological interventions should be initiated when BP is in the high-normal range... Evidence suggests the benefit of antihypertension in this patient group is afforded by BP reduction... Patients with coronary heart disease (CHD) often have a history of hypertension and the risk of a fatal or non-fatal coronary event post MI is greater if BP is elevated... The Guidelines recommend post-MI administration of BB, ACEI or ARBs, which have been shown to reduce the incidence of recurrent MI and death largely because of direct organ protective properties of the agents, but may be supported by the associated reduction in BP as a result of these agents... In permanent AF, BB and non-dihydropiridine CA remain important classes of drugs for the control of ventricular rate... Both genders respond to antihypertensive agents and benefit from the effects of lowering BP, but there are additional considerations that should be taken into account when prescribing for women... Low-dose aspirin should also be considered in patients with hypertension who are ≥50 years old, even in those without a history of CVD, if they have a moderate increase in serum creatinine or high CV risk... In all these conditions, the benefit-to-risk ratio (weighed as a reduction of MI risk against bleeding) has been proven favorable... Frequency of visits can be reduced considerably once target BP and other treatment goals have been achieved, eg, every 6 months for patients with low additional CV risks, but more frequently where there are concomitant risk factors.

Show MeSH
Related in: MedlinePlus