2023 ESH Guidelines for the management of arterial hypertension
The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH)
The European Society of Hypertension (ESH) recently announced it has published new recommendations for the management of arterial hypertension. The updated 2023 ESH Guidelines for the Management of Arterial Hypertension are designed to serve as an essential resource for health care professionals who treat patients with hypertension. The new guidelines were presented at the 32nd annual European Meeting on Hypertension and Cardiovascular Protection held June 24-26 in Milan, Italy, and published in Journal of Hypertension.
Prof. Mancia stated in the ESH announcement, “We believe providing updated guidelines for the treatment of hypertension is vital to ensuring clinicians have the latest recommendations for treating the billions of people around the world with hypertension. We look forward to seeing the impact these guidelines have, especially for patients who do not adhere to medication.”
“These new guidelines offer significant changes in understanding and a more customized approach to different patient audiences as this public health crisis continues to grow on a global scale,” added Prof. Kreutz. “These new guidelines offer, for the first time, recommendations for additional patient populations, including women, children, and adolescents, as well as the impact of COVID-19 and comorbidities such as obesity, heart disease, chronic kidney disease, and diabetes on uncontrolled hypertension.”
WHAT IS NEW AND WHAT HAS CHANGED IN THE 2023 EUROPEAN SOCIETY OF HYPERTENSION ARTERIAL HYPERTENSION GUIDELINES? *
2. Pathophysiological background of primary hypertension
3. Clinical BP measurements by different methods and in different settings and clinical conditions
4. Thorough description of office, ambulatory and home BP measurements and value in different demographic and clinical conditions
5. Upgrading of out-of-office BP measurements in hypertension management
6. New HMOD measurements and their clinical value in hypertension work-up
7. New CV risk factors and update on CV risk assessment
8. Update and comprehensive summary of secondary forms of hypertension
9. Update on lifestyle interventions
10. Update on threshold and targets for antihypertensive drug treatment, including their possible heterogeneity in demographic and clinical subgroups of patients
11. Confirmation of preferred use of RAS blockers, CCBs and Thiazide/Thiazide-like diuretics, and their various combinations for BP-lowering treatment. Inclusion of BBs among the major antihypertensive drugs
12. Update on available combination-based drug treatment strategies, including the quadpill and the polypill
13. Emphasis and update on the diagnosis and management of true-resistant hypertension
14. Update on use and position of renal denervation for antihypertensive treatment
15. Impact of hypertension and its treatment on cognitive dysfunction and dementia
16. Management of hypertension in older people according to the frailty and functional level
17. Update on treatment of hypertension in HFrEF and HFpEF
18. New diagnostic approaches to diagnosis and treatment in hypertensive patients with AF
19. Update on treatment in CKD, including kidney transplantation
20. Update and novel treatment approaches to patients with type 2 diabetes
21. Epidemiology, diagnosis and treatment in different BP phenotypes
22. Diagnosis, treatment and follow-up of hypertension in demographic and clinical conditions not or only marginally addressed in previous guidelines:
a. Children/adolescents and transition to adulthood
b. Young patients
c. Sex-related differences
d. Pregnancy and puerperium
e. Peripheral artery disease
f. Aortic aneurism
g. Valvular heart disease
h. Treatment of hypertension in acute cerebrovascular diseases
i. Hypertensive emergencies/urgencies
j. Perioperative hypertension
k. Obesity
l. COVID-19
m. Chronic inflammatory diseases
n. Hypertension in oncology
o. Baroreflex failure and dysautonomia
p. Glaucoma
23. Detailed recommendations on patients’ follow-up strategies, including assessment and minimization of nonadherence and clinical inertia.
24. Mention of new potential approaches to the treatment of hypertension and containment of hypertension-related workload (tele-health, team-based treatment, role of pharmacists)
