What’s New in the 2013 ESC/ESH Hypertension Guideline Prof. Vang Chu MD., PhD., FAsCC, FACC, FESC Director of the Lao-Luxembourg Heart Cente Mahosot Hospital, Lao University of Health Sciences

Introduction

Table 1: Classes of Recommendations

Table 2: Levels of Evidence

New Aspects in 2013 ESC HTN Guideline Update of the prognostic significance of night- time BP, white coat hypertension and masked hypertension. Update of the prognostic significance of asymptomatic OD, including heart, blood vessels, kidney, eye and brain. Initiation of antihypertensive treatment. More evidence-based criteria and no drug treatment of high normal BP.

Revised schema for priorital two-drug combinations. New therapeutic algorithms for achieving target BP. Revised recommendations on treatment of hypertension in the elderly.

HTN Diagnosis & Evaluation

Table 6: Definitions of hypertension by office and out-of-office blood pressure levels

Table 7: Clinical indications for out-of-office blood pressure measurement for diagnostic purposes

Table 3: Definitions and classification of office blood pressure levels (mmHg)a

Treatment initiation

ESC 2013 HTN Guideline

Figure 1: Stratification of total CV risk in categories of low, moderate, high and very high risk according to SBP and DBP and prevalence of RFs, asymptomatic OD, diabetes, CKD stage or symptomatic CVD.

Summary of total cardiovascular risk assessment

Initiation of anti-hypertensive treatment in 2007 ESC guideline

Figure 2: Initiation of lifestyle changes and antihypertensive drug treatment.

In patients with diabetes, the optimal DBP target is between 80 and 85 mmHg. In the high normal BP range, drug treatment should be considered in the presence of a raised out-of-office BP (masked hypertension). Lack of evidence in favour of drug treatment in young individuals with isolated systolic hypertension.

HTN Treatment strategies

Summary of adoption of lifestyle changes

Table 14: Compelling and possible contra-indications to the use of antihypertensive drugs

Table 15: Drugs to be preferred in specific conditions

Figure 3: Monotherapy vs Figure 3: Monotherapy vs. drug combination strategies to achieve target BP. Moving from a less intensive to a more intensive therapeutic strategy should be done whenever BP target is not achieved.

Figure 4: Possible combinations of classes of antihypertensive drugs.

HTN Treatment strategies in special conditions

Summary of treatment strategies in white-coat and masked hypertension

Summary of antihypertensive treatment strategies in the elderly

Summary of treatment strategies in hypertensive women

Summary of treatment strategies in patients with diabetes

Summary of treatment strategies in hypertensive patients with metabolic syndrome

Summary of therapeutic strategies in hypertensive patients with nephropathy

Summary of therapeutic strategies in hypertensive patients with cerebrovascular disease

Summary of therapeutic strategies in hypertensive patients with heart disease

Summary of therapeutic strategies in hypertensive patients with atherosclerosis, arteriosclerosis, and peripheral artery disease

Summary of therapeutic strategies in patients with resistant hypertension

Thank you for your attention Any Questions ?