Editors’ Commentary on the 2023 ESH Management of Arterial Hypertension Guidelines

Abstract

Clinical practice guidelines are ideally suited to the provision of advice on the prevention, diagnosis, evaluation, and management of high blood pressure (BP). The recently published European Society of Hypertension (ESH) 2023 ESH Guidelines for the management of arterial hypertension is the latest in a long series of high BP clinical practice guidelines. It closely resembles the 2018 European Society of Cardiology/ESH guidelines, with incremental rather than major changes. Although the ESH guidelines are primarily written for European clinicians and public health workers, there is a high degree of concordance between its recommendations and those in the other major BP guidelines. Despite the large number of national and international BP guidelines around the world, general population surveys demonstrate that BP guidelines are not being well implemented in any part of the world. The level of BP, which is the basis for diagnosis and management, continues to be poorly measured in routine clinical practice and control of hypertension remains sub-optimal, even to a conservative blood pressure target such as a systolic/diastolic BP <140/90 mm Hg. BP guidelines need to focus much more on implementation of recommendations for accurate diagnosis and strategies for improved control in those being treated for hypertension. An evolving body of implementation science can assist in meeting this goal. Given the enormous health, social, and financial burden of high BP better diagnosis and management should be an imperative for clinicians, government, and others responsible for the provision of healthcare services. Hopefully, the 2023 ESH will help enable this.

Association between AST/ALT ratio and diabetic retinopathy risk in type 2 diabetes: a cross-sectional investigation

“…Fatty liver diagnosis was ultrasound-based ( 30 ). Hypertension was identified through blood pressure measurements, following established criteria ( 31 ). The eGFR calculation employed the Andrew S. Levey formula ( 32 ), with diabetic nephropathy confirmed per KDIGO guidelines when urinary ACR ≥ 30 mg/mmol or eGFR < 60 mL/min/1.73m^ 2 ( 33 ).…”

The Polypill: A New Alternative in the Prevention and Treatment of Cardiovascular Disease

“…On the other hand, while efficacy clinical trials have consistently shown the ability to produce significant drops in blood pressure, post-trial monitoring indicated that these differences gradually decreased until there was no longer any difference in SBP approximately 5 to 6 years after the trial’s termination, suggesting that the current model of care is not producing satisfactory rates of hypertension control anywhere in the world. The more intensively treated arms in the ACCORD (Action to Control Cardiovascular Risk in Diabetes) and SPRINT (Systolic Blood Pressure Intervention Trial) trials achieved sustained SBP reductions of 14.2 and 16.2 mm Hg, respectively, compared with the standard care arms after treatment titration [ 86 , 87 , 88 ].…”

“…Better blood pressure control for adults with uncomplicated hypertension appears to have been achieved in implementation trials and routine practice settings when using the 2023 ESH Management of Arterial Hypertension Guidelines, which recommend a model that includes elements of accurate and precise blood pressure measurement; health promotion; easy access to a knowledgeable, community-based, patient-centered healthcare team; and the use of simple, evidence-based protocols for lifestyle counseling and antihypertensive drug treatment. Reliability in accessing effective and affordable antihypertensive medications is also recommended, with a preference for the use of single-pill combinations for combination drug therapies [ 22 , 88 ].…”

Prevalence of hypertension in adults living at altitude in Latin America and the Caribbean: A systematic review and meta-analysis

“…providers, and the community [101][102][103]. More studies are needed to evaluate the factors that lead to a lower prevalence of hypertension at altitude, such as length of residence, ethnic origin, in other countries, and other particular characteristics of these populations, such as environmental and lifestyle factors [104].…”