Bài giảng New ESC/ESH Guidelines 2018 for the management of arterial hypertension

Lecture with the content classification and definitions; screening for HTN; screening and diagnosis of hypertension; threshold for therapy; office blood pressure thresholds for treatment; treshold for initiation of therapy; targets for therapy...

New ESC/ESH Guidelines 2018 for

the management of arterial

hypertension

Pr Jean-Luc Vandenbossche

CHU St-Pierre ULB

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• Recent clinical studies justifying changes in guidelines

• New concepts in 2018

• Key messages

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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

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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

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Classification and Definitions

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SCREENING for HTN

KEY MESSAGES

Threshold for therapy

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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

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