Blood Pressure, 2014; 23: 1–2

EDITORIAL

Hypertension Management by Practice Guidelines

SVERRE E. KJELDSEN1, KRZYSTOF NARKIEWICZ2, SUZANNE OPARIL3 & THOMAS HEDNER4

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1Department

of Cardiology, University of Oslo, Ullevaal Hospital, Oslo, Norway, 2Department of Hypertension and Diabetology, Medical University of Gdansk, Poland, 3Vascular Biology and Hypertension Program, University of Alabama at Birmingham, USA, and 4Department of Medicine, University of Göteborg, Sahlgrenska Academy, Göteborg, Sweden

Since first published in 2003, European and other guidelines on hypertension management have ranked among the most cited papers in the medical literature (see 1). Although progress has been made over the past decade, hypertension awareness, treatment and control are still far from optimal in most parts of the world. Therefore, there has been a need to provide more easily accessible information to the practising physician. To meet that demand, shorter “Practice Guidelines” have recently been published from the ESH/ESC, ISH/ASH, AHA/ACC (2–4) and most recently from the panel members appointed to the Eighth Joint National Committee (JNC 8) in the U.S.A. (5). In this issue of Blood Pressure, we provide the full text of the “2013 ESH/ESC Practice Guidelines for the Management of Arterial Hypertension” by the ESH-ESC Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) (2). This important document is provided exclusively to the medical profession by the two ESH endorsed journals, i.e. Journal of Hypertension and Blood Pressure. The Editors of Blood Pressure are grateful to Alberto Zanchetti, Editor-in-Chief of Journal of Hypertension, for his kind cooperation and commitment to put these practice guidelines together and publish them in both journals. These documents provide largely similar information on drug treatment of hypertension, albeit there are some important differences. For example, the ISH-ASH guidelines do not differ very much from the 2013 ESH-ESC guidelines except that beta-blockers are not recommended as first line treatment in the ISH-ASH document (2,3). Further, the recent AHA-ACC guidelines still recommend

“diuretics as first line treatment for most patients” (4), a strategy that has been abandoned by most guideline development committees. Consistent with ESH-ESC and ISH-ASH, the panel members appointed to JNC8 (5) support initiating treatment with either an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic, without preference for any of the classes in the general population of hypertensive patients. They do not recommend beta-blockers as first line treatment, and do recommend 150 mmHg as the threshold systolic blood pressure for pharmacologic treatment of persons 60 years of age and older. Since both the direct and indirect costs of hypertension related complications are very high, it is imperative to facilitate effective approaches to achieve optimal hypertension management in individual patients as well as in the population. High quality hypertension management needs input from all relevant stakeholders, i.e. patients, families, providers and healthcare delivery systems, as well as the community at large. In that respect, publication and dissemination of easy-to-access information on evidence-based treatment is critical to achieving improved control of blood pressure in our patients. We are delighted to provide the “2013 ESH/ESC Practice Guidelines for the Management of Arterial Hypertension” by the ESH-ESC Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) to our readers. Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

ISSN 0803-7051 print/ISSN 1651-1999 online © 2014 Scandinavian Foundation for Cardiovascular Research DOI: 10.3109/08037051.2014.881646

2

S. E. Kjeldsen et al.

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References 1. Kjeldsen SE, Narkiewicz K, Oparil S, Hedner T. 2013 European Society of Hypertension/European Society of Cardiology Hypertension Guidelines. Blood Press 2013; 22:191–192. 2. The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). 2013 ESH/ESC Practice Guidelines for the Management of Arterial Hypertension by the ESH-ESC. Blood Press 2014;23:3–16. 3. Weber MA, Schiffrin EL, White WB, Mann S, Lindholm LH, Kenerson JG, Flack JM, Carter BL, Materson BJ, Ram CVS, Cohen DL, Cadet J-C, Jean-Charles RR, Taler S, Kountz D, Townsend R, Chalmers J, Ramirez AJ, Bakris GL, Wang J, Schutte AE, Bisognano JD, Touyz RM, Sica D, and Harrap SB. Clinical Practice Guidelines for the Management of Hypertension in the Community. A Statement by the American

Society of Hypertension and the International Society of Hypertension. J Hypertens 2014;32:3–15. 4. Go AS, Bauman MA, Coleman King SM, Fonarow GC, Lawrence W, Williams KA, Sanchez E. An Effective Approach to High Blood Pressure Control. A Science Advisory From the American Heart Association, the American College of Cardiology, and the Centre for Disease Control and Prevention. Hypertension; Early online: November 15, 2013; http://hyper.ahajournals.org/content/early/2013/11/14/HYP. 0000000000000003.citation. 5. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, Lackland DT, LeFevre ML, MacKenzie TD, Ogedegbe O, Smith Jr SC, Svetkey LP, Taler SJ, Townsend RR, Wright Jr JT, Narva AS, Ortiz E. 2014 evidence-based guideline for the management of high blood pressure in adults report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA; Early online: December 18, 2013. DOI:10.1001/ jama.2013.284427.