Approaches to the Diagnosis and Treatment of Arterial Hypertension in the Light of European Recommendations

In this review we present analysis the European recommendations on hypertension – what’s new and what has changed in the tactics of managing patients with arterial hypertension (AH). We compared recommendations on hypertension of the European Society of Cardiology (ESC) and the European Society of hypertension (ESH) 2018 with European recommendations of previous years. In the updated version of guidelines, it is still recommended to determine AH as blood pressure (BP) ≥140 and / or ≥90 mm Hg; to subdivide BP levels into optimal, normal, and high normal, to classify severity of AH as 3 degrees, and to distinguish separately its isolated systolic form. Values for out-of-office BP remained unchanged, but recommendations emerged concerning wider use of ambulatory BP monitoring and self-measurement of BP. For initial therapy, it was recommended to use two drugs combinations preferably as single pill combinations. An increase of the role of nurses and pharmacists in teaching, supporting patients and controlling hypertension has been noted. This can improve the achievement of target BP and, as a result, reduce the cardiovascular risk. New European recommendations highlight the modern aspects of classification and diagnosis of AH, main stages of screening, and algorithm of drug treatment of AH.

1. Boytsov S.A., Balanova Yu.A., Shal’nova S.A., Deev A.D., Artamonova G.V., Gatagonova T.M. et al. Arterial hypertension among persons aged 25-64: prevalence, awareness, treatment and control. By the data from ECCD. Cardiovascular Therapy and Prevention. 2014;13(4):4–14. DOI: 10.15829/1728-8800-2014-4-4-14

2. Chazova I.E., Oshchepkova E.V. The experience of dealing with cardiovascular diseases in Russia. Analytical Bulletin of the Federation Council of the Federal Assembly RF. 2015;44:4–8.

3. Forouzanfar MH, Liu P, Roth GA, Ng M, Biryukov S, Marczak L et al. Global Burden of Hypertension and Systolic Blood Pressure of at Least 110 to 115 mm Hg, 1990-2015. JAMA. 2017;317(2):165–82. DOI: 10.1001/jama.2016.19043

4. Johnson KC, Whelton PK, Cushman WC, Cutler JA, Evans GW, Snyder JK et al. Blood Pressure Measurement in SPRINT (Systolic Blood Pressure Intervention Trial). Hypertension. 2018;71(5):848–57. DOI: 10.1161/HYPERTENSIONAHA.117.10479

5. Foy AJ, Mandrola JM. Heavy Heart: The economic burden of heart disease in the United States Now and in the future. Primary Care: Clinics in Office Practice. 2018;45(1):17–24. DOI: 10.1016/j.pop.2017.11.002

6. Forouzanfar MH, Alexander L, Anderson HR, Bachman VF, Biryukov S, Brauer M et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet. 2015;386(10010):2287–323. DOI: 10.1016/S0140-6736(15)00128-2

7. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. Journal of Hypertension. 2018;36(10):1953–2041. DOI: 10.1097/HJH.0000000000001940

8. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Russian Journal of Cardiology. 2018;23(12):143–228. DOI: 10.15829/1560-4071-2018-12-143-228

9. Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Journal of Hypertension. 2013;31(7):1281–357. DOI: 10.1097/01.hjh.0000431740.32696.cc

10. Tucker KL, Sheppard JP, Stevens R, Bosworth HB, Bove A, Bray EP et al. Self-monitoring of blood pressure in hypertension: A systematic review and individual patient data meta-analysis. PLOS Medicine. 2017;14(9):e1002389. DOI: 10.1371/journal.pmed.1002389