New American and European Hypertension Guidelines, Reconciling the Differences

Area of Science:

• Cardiology
• Clinical Practice Guidelines
• Public Health

Background:

• The American College of Cardiology/American Heart Association (ACC/AHA) released new hypertension guidelines in 2017.
• These guidelines replaced the Joint National Committee (JNC) reports, last updated in 2003.
• The European Society of Cardiology/European Society of Hypertension (ESC/ESH) updated their guidelines in 2018.

Purpose of the Study:

• To compare the main differences between the 2017 ACC/AHA and 2018 ESC/ESH hypertension guidelines.
• To analyze the arguments supporting the divergent recommendations.
• To discuss the potential impact on clinical hypertension management.

Main Methods:

• Comparative analysis of the 2017 ACC/AHA and 2018 ESC/ESH hypertension guidelines.
• Review of expert arguments and rationale for guideline discrepancies.
• Discussion of clinical implications for hypertension detection, diagnosis, and treatment.

Main Results:

• The ACC/AHA guidelines introduce a disruptive new definition of hypertension, lowering the threshold to 130/80 mmHg.
• This change impacts hypertension prevalence and alters therapeutic strategies, including treatment initiation and blood pressure targets.
• While European guidelines show minimal changes, American proposals represent a significant shift.

Conclusions:

• The divergent hypertension guidelines present distinct approaches to diagnosis and therapy.
• The new American definition and treatment recommendations may significantly alter clinical practice.
• Understanding these differences is crucial for effective hypertension management globally.