2018ESC/ESH Guidelines for the management ofarterial ...

1 2018 ESC/ESH Guidelines for the managementof arterial hypertensionThe Task Force for the management of arterial hypertension of theEuropean society of cardiology (ESC) and the european society ofHypertension (ESH)Authors/Task Force Members: Bryan Williams* (ESC Chairperson) (UK),Giuseppe Mancia* (ESH Chairperson) (Italy), Wilko Spiering (The Netherlands),Enrico Agabiti Rosei (Italy), Michel Azizi (France), Michel Burnier (Switzerland),Denis L. Clement (Belgium), Antonio Coca (Spain), Giovanni de Simone (Italy),Anna Dominiczak (UK), Thomas Kahan (Sweden), Felix Mahfoud (Germany),Josep Redon (Spain), Luis Ruilope (Spain), Alberto Zanchetti (Italy), Mary Kerins(Ireland), Sverre E. Kjeldsen (Norway), Reinhold Kreutz (Germany),Stephane Laurent (France), Gregory Y. H. Lip (UK), Richard McManus (UK),Krzysztof Narkiewicz (Poland), Frank Ruschitzka (Switzerland),Roland E.

2 Schmieder (Germany), Evgeny Shlyakhto (Russia), Costas Tsioufis(Greece), Victor Aboyans (France), Ileana Desormais (France)* Corresponding authors. Bryan Williams, Institute of Cardiovascular Science, University College London, Maple House, 1st Floor, Suite A, 149 Tottenham Court Road, LondonW1T 7DN, UK, Tel: 44 (0) 20 3108 7907, E-mail: Giuseppe Mancia, University of Milano-Bicocca, Milan, Italy; and Hypertension Center IstitutoUniversitario Policlinico di Monza, Verano (MB), Piazza dei Daini, 4 20126 Milan, Italy, Tel: 39 347 4327142, E-mail: Professor Zanchetti died towards the end of the development of these Guidelines , in March 2018. He contributed fully to the development of these Guidelines , as a memberof the Guidelines Task Force and as a section co-ordinator.

3 He will be sadly missed by colleagues and two chairpersons contributed equally to the Committee for Practice Guidelines (CPG), european society of Hypertension (ESH) Council, ESC National Cardiac Societies having participated inthe review process, ESH National Hypertension Societies having participated in the review process: listed in the entities having participated in the development of this document:Associations: european Association of Cardiovascular Imaging (EACVI), european Association of Preventive cardiology (EAPC), european Association of PercutaneousCardiovascular Interventions (EAPCI), european Heart Rhythm Association (EHRA), Heart Failure Association (HFA).Councils: Council for cardiology Practice, Council on Cardiovascular Nursing and Allied Professions, Council on Cardiovascular Primary Care, Council on Hypertension,Council on Groups: Cardiovascular Pharmacotherapy, Coronary Pathophysiology and Microcirculation, ESC/ESH Guidelines represent the views of the ESC and ESH and were produced after careful consideration of the scientific and medical knowledge andthe evidenceavailable at the time of their dating.

4 The ESC and ESH are not responsible in the event of any contradiction, discrepancy, and/or ambiguity between theESC/ESH Guidelines and any otherofficial recommendations or Guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals areencouraged to take the ESC/ESH Guidelines fully into account when exercising their clinical judgment as well as in the determination and the implementation of preventive, diagnostic, ortherapeutic medical strategies. However, the ESC/ESH Guidelines do not override in any way whatsoever the individual responsibility of health professionals to make appropriate and accu-rate decisions in consideration of each patient s health condition, and in consultation with that patient and the patient s caregiver where appropriate and/or necessary.

5 Nor do the ESC/ESHG uidelines exempt health professionals from taking careful and full consideration of the relevant official updated recommendations or Guidelines issued by the competent public healthauthorities in order to manage each patient s case in light of the scientifically accepted data pursuant to their respective ethical and professionalobligations. It is also the health professional sresponsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of content of these european society of cardiology (ESC) and european society of Hypertension (ESH) Guidelines has been published for personal and educational use commercial use is authorized. No part of the ESC/ESH Guidelines may be translated or reproduced in any form without written permission from the ESC or can be obtained upon submission of a written request to Oxford University Press, the publisher of the european Heart Journal and the party authorized to handlesuch permissions on behalf of the ESC article has been co-published in theEuropean Heart Journal(doi: ) andJournal of Hypertension( ), and ina shortened version inBlood Pressure.

6 All rights society of cardiology and european society of Hypertension 2018. The articles inEuropean Heart JournalandJournal of Hypertensionare identical except for minor stylistic and spelling differences in keeping with each journal s style. Any citation can be used when citing this Heart Journal (2018)00,1 98 ESC/ESH from gueston 26 August Reviewers: Guy De Backer (ESC Review Co-ordinator) (Belgium), Anthony M. Heagerty (ESHR eview 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 fkov a (Czech Republic), John G. F. Cleland (UK),Jean-Philippe Collet (France), Ioan Mircea Coman (Romania), Peter W.

7 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 LorenzaMuiesan (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.

8 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 theESC website Hypertension Blood pressure Blood pressure measurement Blood pressure treatmentthresholds and targets Hypertension-mediated organ damage Lifestyle interventions Drug therapy Combination therapy Device therapy Secondary hypertensionTable of Contents1 Preamble ..52 Introduction .. What is new and what has changed in the 2018 EuropeanSociety of cardiology / european society of HypertensionarterialhypertensionGuidelin es?

9 73 Definition, classification, and epidemiological Blood pressure relationship with risk of cardiovascular Hypertension and total cardiovascular risk assessment .. Importance of hypertension-mediated organ damage inrefining cardiovascular risk assessment in hypertensive patients .. Challenges in cardiovascular risk assessment.. Conventional office blood pressure measurement .. Unattended office blood pressure measurement.. Out-of-office blood pressure measurement .. Advantages and disadvantages of ambulatory blood pressuremonitoring and home blood pressure monitoring .. White-coat hypertension and masked hypertension .. Clinical indications for out-of-office Blood pressure during exercise and at high altitude .. Clinical evaluation and assessment of Physical examination and clinical investigations.

10 Assessment of hypertension-mediated organ damage .. Using hypertension-mediated organ damage to Characteristics of hypertension-mediated organ damage .. The blood vessels in hypertension .. GuidelinesDownloaded from gueston 26 August Hypertension-mediated organ damage regression andcardiovascular risk reduction with antihypertensive treatment .. When to refer a patient with hypertension .. Beneficial effects of blood pressure-lowering When to initiate antihypertensive treatment .. Recommendations in previous Guidelines .. Drug treatment for patients with grade 1hypertension at low moderate cardiovascular risk .. Initiation of blood pressure-lowering drugtreatment in older people with grade 1 hypertension .. Initiation of blood pressure-lowering drugtreatment in patients with high normal blood pressure.