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American, European and international hypertension guidelines: Time to shake hands?

Christina Antza1, Ioannis Doundoulakis1,2, Stella Stabouli2,3

  • 13rd Department of Internal Medicine, Aristotle University, Hypertension, Hypertension-24h Ambulatory Blood Pressure Monitoring Center, Papageorgiou Hospital, Thessaloniki, Greece.

International Journal of Cardiology. Hypertension
|April 22, 2021
PubMed

Insights

Major hypertension guidelines differ on treatment initiation, leading to patient misclassification and confusion. These discrepancies impact cardiovascular risk assessment and treatment decisions for many individuals.

Area of Science:

  • Cardiology
  • Hypertension Management
  • Evidence-Based Medicine

Background:

  • Adhering to evidence-based medicine guidelines is crucial for effective hypertension treatment and preventing cardiovascular events.
  • Current hypertension management relies on guidelines from major international societies.

Purpose of the Study:

  • To compare recent hypertension guidelines from the American College of Cardiology/American Heart Association (ACC/AHA), European Society of Cardiology/European Society of Hypertension (ESC/ESH), and International Society of Hypertension (ISH).
  • To identify key discrepancies in guideline recommendations regarding treatment initiation criteria (when, how, and in whom).

Main Methods:

  • Comparative analysis of the latest ACC/AHA, ESC/ESH, and ISH hypertension guidelines.
  • Focus on contrasting recommendations for initiating antihypertensive therapy.

Main Results:

  • Significant disagreements exist among the three guidelines regarding the definition of hypertension, specifically cut-off blood pressure values.
  • Divergent cut-off values can lead to misclassification of patients into different blood pressure phenotypes.
  • Each guideline proposes distinct risk stratification scores for assessing cardiovascular risk in hypertensive patients.

Conclusions:

  • Discrepancies in hypertension guidelines create confusion for both general practitioners and specialists.
  • Poor agreement between guidelines and diagnostic tools may result in a substantial number of patients not receiving appropriate treatment.
  • Harmonization of guidelines is needed to ensure consistent and optimal patient care.
Abstract

Keywords:
ACC/AHA, American College of Cardiology and American Heart AssociationASCVD, Atherosclerotic Cardiovascular DiseaseAmerican hypertension GuidelinesBP, Blood PressureBlood pressureESC/ESH, European Society of Cardiology and European Society of HypertensionEuropean hypertension guidelinesHypertensionISH, International Society of HypertensionInternational hypertension guidelinesSCORE, Systematic Coronary Risk Evaluation

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