New ESC/ESH Guidelines 2018 for the management of arterial

hypertension

Pr Jean-Luc Vandenbossche CHU St-Pierre ULB

• Recent clinical studies justifying changes in guidelines

• New concepts in 2018

• Key messages

SPRINT

SPRINT Research Group, Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV, Reboussin DM, Rahman M, Oparil S, Lewis CE, Kimmel PL, Johnson KC, Goff DC Jr, Fine LJ, Cutler JA, Cushman WC, Cheung AK, Ambrosius WT. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 2015;373:2103–2116.

At baseline

HOPE-3

NO BENEFIT TO TREAT <140 and low CV risk

Prespecified subgroups on baseline BP)

Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering treatment in hypertension: 8. Outcome reductions vs. discontinuations because of adverse drug events -meta-analyses of randomized trials. J Hypertens 2016;34:1451–1463.

Relation intensité vs bénéfice et effets secondaires

Classification and Definitions

SCREENING for HTN

KEY MESSAGES

Threshold for therapy

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

Treshold for initiation of therapy

• <80y: from 140/90

• <80y + CAD/stroke: from 130/85

• >80y: from 160/90

Targets for therapy

120-130

130-140

70-80

Targets for therapy

• For all patients: <140/ <90

• For <65y: 120 -130/70-80 (« 125/75 »)

• For >65y: 130 -140/70-80 (« 135/75 »)

DRUG Therapy

Thank you for your attention

DIAGNOSTIC , TRESHOLDS AND TARGETS

(140-160)

>80 y: >160mmHg

65< age<80

Tresholds

THERAPEUTIC TARGETS

INCLUDED >80y