European Heart Journal Advance Access originally published online on June 11, 2007
European Heart Journal 2007 28(12):1462-1536; doi:10.1093/eurheartj/ehm236
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
2007 Guidelines for the management of arterial hypertension
The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)
Authors/Task Force Members:,
(Italy)
(Belgium)
(UK)
(Czech Republic)
(Belgium)
(Italy)
(Italy)
(UK)
(Norway)
(France)
(Poland)
(Spain)
(Poland)
(Germany)
(Netherlands)
(Italy)
ESC Committee for Practice Guidelines (CPG):,
(France)
(United Kingdom)
(Italy)
(France)
(Norway)
(Greece)
(France)
(Netherlands)
(Denmark)
(France)
(Germany)
(Germany)
(Poland)
(Czech Republic)
(Spain)
ESH Scientific Council:,
(Norway)
(Turkey)
(Poland)
(Switzerland)
(Italy)
(Italy)
(Czech Republic)
(United Kingdom)
(Belgium)
(France)
(Sweden)
(Italy)
(Greece)
(Sweden)
(Spain)
(Germany)
(The Netherlands)
(Estonia)
Document Reviewers:,
(Greece)
(Greece)
(Italy)
(Italy)
(Spain)
(Belgium)
(Turkey)
(Hungary)
(Romania)
(Switzerland)
(UK)
(France)
(Greece)
(Sweden)
(Ireland)
(Poland)
(Spain)
(Switzerland)
(Spain)
(Netherlands)
(Estonia)
(Switzerland)
(UK)
(Spain)
* Correspondence to Giuseppe Mancia, Clinica Medica, Ospedale San Gerardo, Universita Milano-Bicocca, Via Pergolesi, 33 – 20052 MONZA (Milano), Italy Tel: +39 039 233 3357; fax: +39 039 32 22 74, e-mail: giuseppe.mancia@unimib.it
* Correspondence to Guy de Backer, Dept. of Public Health, University Hospital, De Pintelaan 185, 9000 Ghent, Belgium Tel: +32 9 240 3627; fax: +32 9 240 4994; e-mail: Guy.DeBacker@ugent.be
The affiliations of Task Force members are listed in the Appendix. Their Disclosure forms are available on the respective society Web Sites. These guidelines also appear in the Journal of Hypertension, doi:10.1097/HJH.0b013e3281fc975a
The content of these European Society of Cardiology (ESC) Guidelines has been published for personal and educational use only. No commercial use is authorized. No part of the ESC Guidelines may be translated or reproduced in any form without written permission from the ESC. Permission can be obtained upon submission of a written request to Oxford University Press, the publisher of the European Heart Journal and the party authorized to handle such permissions on behalf of the ESC.
Disclaimer. The ESC Guidelines represent the views of the ESC and were arrived at after careful consideration of the available evidence at the time they were written. Health professionals are encouraged to take them fully into account when exercising
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1. Introduction and purposes |
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2. Definition and classification of hypertension |
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2.1 Systolic versus diastolic and pulse pressure
2.2 Classification of hypertension
2.3 Total cardiovascular risk (Box 1)
2.3.1 Concept
2.3.2 Assessment
2.3.3 Limitations
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3. Diagnostic evaluation |
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3.1 Blood pressure measurement
3.1.1 Office or clinic blood pressure
3.1.2 Ambulatory blood pressure (Box 3)
3.1.3 Home blood pressure (Box 3)
3.1.4 Isolated office or white coat hypertension
3.1.5 Isolated ambulatory or masked hypertension
3.1.6 Blood pressure during exercise and laboratory stress
3.1.7 Central blood pressure
3.2 Family and clinical history (Box 4)
3.3 Physical examination (Box 5)
3.4 Laboratory investigations (Box 6)
3.5 Genetic analysis
3.6 Searching for subclinical organ damage (Box 7)
3.6.1 Heart
3.6.2 Blood vessels
3.6.3 Kidney
3.6.4 Fundoscopy
3.6.5 Brain
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4. Evidence for therapeutic management of hypertension |
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4.1 Introduction
4.2 Event based trials comparing active treatment to placebo
4.3 Event based trials comparing more and less intense blood pressure lowering
4.4 Event based trials comparing different active treatments
4.4.1 Calcium antagonists versus thiazide diuretics and ß-blockers
4.4.2 ACE inhibitors versus thiazide diuretics and ß-blockers
4.4.3 ACE inhibitors versus calcium antagonists
4.4.4 Angiotensin receptor antagonists versus other drugs
4.4.5 Trials with ß-blockers
4.4.6 Conclusions
4.5 Randomized trials based on intermediate endpoints
4.5.1 Heart
4.5.2 Arterial wall and atherosclerosis
4.5.3 Brain and cognitive function
4.5.4 Renal function and disease
4.5.5 New onset diabetes
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5. Therapeutic approach |
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5.1 When to initiate antihypertensive treatment
5.2 Goals of treatment (Box 8)
5.2.1 Blood pressure target in the general hypertensive population
5.2.2 Blood pressure targets in diabetic and very high or high risk patients
5.2.3 Home and ambulatory blood pressure targets
5.2.4 Conclusions
5.3 Cost-effectiveness of antihypertensive treatment
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6. Treatment strategies |
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6.1 Lifestyle changes (Box 9)
6.1.1 Smoking cessation
6.1.2 Moderation of alcohol consumption
6.1.3 Sodium restriction
6.1.4 Other dietary changes
6.1.5 Weight reduction
6.1.6 Physical exercise
6.2 Pharmacological therapy (Boxes 10 and 11)
6.2.1 Choice of antihypertensive drugs
6.2.2 Monotherapy (Box 12)
6.2.3 Combination treatment (Box 12)
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7. Therapeutic approach in special conditions |
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7.1 Elderly (Box 13)
7.2 Diabetes mellitus (Boxes 14 and 15)
7.3 Cerebrovascular disease (Box 16)
7.3.1 Stroke and transient ischaemic attacks
7.3.2 Cognitive dysfunction and dementia
7.4 Coronary heart disease and heart failure (Box 17)
7.5 Atrial fibrillation
7.6 Non-diabetic renal disease (Box 15)
7.7 Hypertension in women (Box 18)
7.7.1 Oral contraceptives
7.7.2 Hormone replacement therapy
7.7.3 Hypertension in pregnancy
7.8 Metabolic syndrome (Box 19)
7.9 Resistant hypertension
7.10 Hypertensive emergencies
7.11 Malignant hypertension
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8. Treatment of associated risk factors (Box 21) |
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8.1 Lipid lowering agents
8.2 Antiplatelet therapy
8.3 Glycaemic control
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9. Screening and treatment of secondary forms of hypertension |
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9.1 Renal parenchymal disease
9.2 Renovascular hypertension
9.3 Phaeochromocytoma
9.4 Primary aldosteronism
9.5 Cushing's syndrome
9.6 Obstructive sleep apnoea
9.7 Coarctation of the aorta
9.8 Drug-induced hypertension
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10. Follow-up (Box 22) |
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11. Implementation of guidelines |
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APPENDIX: |
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TASK FORCE MEMBERS
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Footnotes |
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References |
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