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[Recommendations on arterial hypertension 2007: text, context, and speculations]
Kardiologiia
|February 12, 2008
Summary
The Second European Recommendations on Arterial Hypertension (AH) update guidelines, emphasizing lower blood pressure targets for high-risk patients and introducing concepts like masked AH. Lifestyle changes remain crucial for AH control.
Area of Science:
- Cardiology and Hypertension Management
- Public Health Policy
- Clinical Practice Guidelines
Background:
- The 2007 European Society on Arterial Hypertension (AH) recommendations revise the 2003 guidelines, reflecting contemporary knowledge on AH.
- These recommendations are educational, not prescriptive, acknowledging varying data proof levels and differing from WHO guidelines by considering European economic potential.
Framework:
- Diagnostic threshold for AH remains 140/90 mm Hg, but lower target values are now required for patients with diabetes, renal insufficiency, proteinuria, and very high cardiovascular risk (e.g., post-myocardial infarction or stroke).
- Introduces novel concepts: "masked (concealed) AH" and "central BP," and emphasizes ambulatory BP monitoring for long-term prognosis.
- Integrates AH into a multiprofile cardiovascular risk assessment framework, acknowledging debates on its primary risk factor status and the importance of European studies alongside Framingham.
Implementation:
- Focuses on achieving target blood pressure (BP) rather than specific drug classes, promoting combined therapy initiation.
- Recommends lifestyle modification as the primary and most effective method for BP control.
- Expands indications for statin prescription and highlights the importance of assessing arterial elasticity and ankle-brachial index, despite limited availability.
Implications:
- The updated guidelines aim for lower, more controlled AH parameters in high-risk populations.
- Promotes a comprehensive approach to cardiovascular risk management, integrating BP with other factors.
- Encourages further development of risk assessment tools like SCORE, which currently focuses solely on mortality.
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