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2013 ESH/ESC Guidelines for the Management of Arterial Hypertension Downloaded from http://eurheartj.oxfordjournals.org/ by guest on November 7, 2013 , Robert Fagard * [email protected] ctor Bueno (Spain), Veronica Dean ´ , doi: 10.3109/08037051.2013.812549. ESH AND ESC GUIDELINES Blood Pressure . Chairperson ESC: Professor Robert Fagard, Hypertension & Cardiovascular 32 16 343 766, Email: + 32 16 348 707, Fax: + [email protected] , 2159–2219 , doi: 10.1097/01.hjh.0000431740.32696.cc and in 34 , Krzysztof Narkiewicz (Section co-ordinator) (Poland), 39 039 322 274. Email: * + hm (Germany), Thierry Christiaens (Belgium), Renata Cifkova ¨ Journal of Hypertension 39 039 233 3357, Fax: + doi:10.1093/eurheartj/eht151 European Heart Journal (2013) The ESH/ESC Guidelines represent the views of the ESH and ESC and were arrived at after careful consideration of the available evidence at the time they were written. phane Laurent (France), Athanasios J. Manolis (Greece), Peter M. Nilsson ´ The European Society of Hypertension (ESH) and European Society of Cardiology (ESC) 2013. All rights reserved. For permissions please email: [email protected]. Corresponding authors: The two chairmen equally contributed to the document. Chairperson ESH: Professor Giuseppe Mancia, Centro di Fisiologia Clinica e Ipertensione, Via F. Sforza, 35, 20121 Milano, Italy. Tel: & * ESH Scientific Council: Josep Redon (President)Peter (Spain), M. Anna Nilsson Dominiczak (Sweden), (UK), Michel Krzysztof BurnierMark Narkiewicz (Switzerland), Caufield (Poland), Margus (UK), Viigimaa Antonio (Estonia), Coca Ettore (Spain),Costas Ambrosioni Michael Tsioufis (Italy), Hecht (Greece), Olsen Philippe (Denmark), van Roland de E. Borne Schmieder (Belgium). (Germany), ESC Committee for Practice Guidelines (CPG):(Germany), Jose Helmut Luis Baumgartner Zamorano (Germany), (Chairperson) Jeroen (Spain), J. Stephan Bax Achenbach (Netherlands), He (France), Christi Deaton (UK), Cetin Erol(Israel), (Turkey), Arno Robert W. Fagard Hoes (Belgium), (Netherlands), Roberto Paulus Ferrari(Belgium), Kirchhof Patrizio (Italy), (Germany/UK), Lancellotti David Juhani Hasdai (Belgium), Knuuti Ales (Finland), LinhartMassimo Philippe (Czech F. Kolh Piepoli Republic), Petros (Italy), Nihoyannopoulos Piotr (UK), PonikowskiMichal (Poland), Tendera Per (Poland), Anton Adam Sirnes Torbicki (Norway), (Poland), Juan William Luis Wijns Tamargo (Belgium), (Spain), Stephan Windecker (Switzerland). Authors/Task Force Members: Giuseppe Mancia (Chairperson) (Italy) of arterial hypertension The Task Force for the managementEuropean of Society of arterial Hypertension hypertension (ESH) of and the of of Cardiology the (ESC) European Society 2013 ESH/ESC Guidelines for the management These guidelines also appear in the Rehab. Unit, KU Leuven University, Herestraat 49, 3000 Leuven, Belgium. Tel: With special thanks to Mrs ClaraOther Sincich ESC and entities Mrs having Donatella participated Mihalich in forESC the their Associations: development contribution. Heart of this Failure document: Association(EACPR), (HFA), European European Heart Association Rhythm Association of (EHRA) CardiovascularESC Imaging Working Groups: (EACVI), Hypertension European and Association the forESC Heart, Councils: Cardiovascular Cardiovascular Cardiovascular Prevention Pharmacology Primary and & Care, Drug Rehabilitation Cardiovascular Therapy The Nursing content and of these Allied European Professions, Society Cardiology of Cardiology Practice mercial (ESC) use and is European authorized. Society No of Hypertension part (ESH) ofmission Guidelines the of has ESC a been Guidelines published written may for request be personal to translated andDisclaimer. Oxford or educational use reproduced University only. in Press, No any the com- form publisher without ofHealth written the professionals permission European from are Heart the encouraged ESC. Journal to Permission and take canhealth the them be professionals party fully obtained to authorized into upon make to sub- account appropriate handle when decisions suchguardian exercising in permissions or their the on carer. clinical circumstances behalf It judgement. of of is The the the also guidelines individual ESC. the do patients, health not, in professional’s however, consultation responsibility override with to the that verify individual patient, the responsibility and rules of where and appropriate regulations and applicable necessary to the drugs patient’s and devices at the time of prescription. Josep Redon (Section co-ordinator) (Spain), Alberto(Italy), Zanchetti Michael (Section co-ordinator) Bo (Sweden), Luis Miguel Ruilope (Spain), RolandPer E. Anton Schmieder Sirnes (Germany), (Norway), Peter SleightBernard (UK), Waeber Margus (Switzerland), Viigimaa Faiez (Estonia), Zannad (France) (Czech Republic), Guy De Backer (Belgium),Maurizio Anna Galderisi Dominiczak (Italy), (UK), Diederick E. Grobbee(Sweden), (Netherlands), Paulus Tiny Kirchhof (Germany/UK), Jaarsma Sverre E.Ste Kjeldsen (Norway), (Chairperson) (Belgium) 2160 ESH and ESC Guidelines Document Reviewers: Denis L. Clement (ESH Review Co-ordinator) (Belgium), Antonio Coca (ESH Review Co-ordinator) (Spain), Thierry C. Gillebert (ESC Review Co-ordinator) (Belgium), Michal Tendera (ESC Review Co-ordinator) (Poland), Enrico Agabiti Rosei (Italy), Ettore Ambrosioni (Italy), Stefan D. Anker (Germany), Johann Bauersachs (Germany), Jana Brguljan Hitij (Slovenia), Mark Caulfield (UK), Marc De Buyzere (Belgium), Sabina De Geest (Switzerland), Genevie`ve Anne Derumeaux (France), Serap Erdine (Turkey), Csaba Farsang (Hungary), Christian Funck-Brentano (France), Vjekoslav Gerc (Bosnia & Herzegovina), Giuseppe Germano (Italy), Stephan Gielen (Germany), Herman Haller (Germany), Arno W. Hoes (Netherlands), Jens Jordan (Germany), Thomas Kahan (Sweden), Michel Komajda (France), Dragan Lovic (Serbia), Heiko Mahrholdt (Germany), Michael Hecht Olsen (Denmark), Jan Ostergren (Sweden), Gianfranco Parati (Italy), Joep Perk (Sweden), Jorge Polonia (Portugal), Bogdan A. Popescu (Romania), Zˇ eljko Reiner (Croatia), Lars Ryde´n (Sweden), Yuriy Sirenko (Ukraine), Alice Stanton (Ireland), Harry Struijker-Boudier (Netherlands), Costas Tsioufis (Greece), Philippe van de Borne (Belgium), Charalambos Vlachopoulos (Greece), Massimo Volpe (Italy), David A. Wood (UK). The affiliations of the Task Force Members are listed in the Appendix. The disclosure forms of the authors and reviewers are available on the respective society websites http://www.eshonline.org and www.escardio.org/guidelines Online publish-ahead-of-print 14 June 2013 ------------------------------------------------------------------------------------------------------------------------------------------------------ Keywords Hypertension † Guidelines † Antihypertensive treatment † Blood pressure † Blood pressure measurement † Cardiovascular risk † Cardiovascular complications † Device therapy † Follow-up † Lifestyle † Organ damage Table of Contents Abbreviations and acronyms . .2162 3.7 Searching for asymptomatic organ damage . .2174 1 Introduction . .2163 3.7.1 Heart . .2174 1.1 Principles . .2163 3.7.2 Blood vessels . .2176 1.2 New aspects . .2163 3.7.3 Kidney . .2176 2 Epidemiological aspects . .2164 3.7.4 Fundoscopy . .2177 2.1 Relationship of blood pressure to cardiovascular and renal 3.7.5 Brain . .2177 damage . .2164 3.7.6 Clinical value and limitations . .2177 2.2 Definition and classification of hypertension . .2165 3.7.7 Summary of recommendations on the search for 2.3 Prevalence of hypertension . .2165 asymptomatic organ damage, cardiovascular disease, and 2.4 Hypertension and total cardiovascular risk . .2165 chronic kidney disease . .2178 2.4.1 Assessment of total cardiovascular risk . .2165 3.8 Searching for secondary forms of hypertension . .2178 2.4.2 Limitations . .2166 4 Treatment approach . .2178 2.4.3 Summary of recommendations on total cardiovascular 4.1 Evidence favouring therapeutic reduction of high blood risk assessment . .2167 pressure . .2178 3 Diagnostic evaluation . .2167 4.2 When to initiate antihypertensive drug treatment . .2178 3.1 Bood pressure measurement . .2168 4.2.1 Recommendations of previous Guidelines . .2178 3.1.1 Office or clinic blood pressure . .2168 4.2.2 Grade 2 and 3 hypertension and high-risk grade 1 3.1.2 Out-of-office blood pressure . .2168 hypertension . .2179 3.1.3 White-coat (or isolated office) hypertension 4.2.3 Low-to-moderate risk, grade 1 hypertension . .2179 and masked (or isolated ambulatory) hypertension . .2170 4.2.4 Isolated systolic hypertension in youth . .2181 3.1.4 Clinical indications for out-of-office blood pressure . .2170 4.2.5 Grade 1 hypertension in the elderly . .2181 3.1.5 Blood pressure during exercise and laboratory stress .2171 4.2.6 High normal blood pressure . .2181 3.1.6 Central blood pressure . .2172 4.2.7 Summary of recommendations on initiation 3.2 Medical history . .2172 of antihypertensive drug treatment . .2181 3.3 Physical examination . .2173 4.3 Blood pressure treatment targets . .2182 3.4 Summary of recommendations on blood pressure 4.3.1 Recommendations of previous Guidelines . .2182 measurement, history, and physical examination . .2173 4.3.2 Low-to-moderate risk hypertensive patients . .2182 3.5 Laboratory investigations . .2173 4.3.3 Hypertension in the elderly . .2182 3.6 Genetics . .2173 4.3.4 High-risk patients . .2182 ESH and ESC Guidelines 2161 4.3.5 The ‘lower the better’ vs. the J-shaped curve 6.10.3 Cognitive dysfunction and white matter lesions . .2200 hypothesis . .2183 6.10.4 Summary of recommendations on therapeutic 4.3.6 Evidence
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