2013 European Society of Hypertension/European Society of Cardiology Hypertension Guidelines

The first European Guidelines on Hypertension were issue in 2003 and published in the Journal of Hypertension. The publication became the most cited paper in medical literature in 2003 and 2004. The second European Guidelines on Hypertension was issued and published in 2007, and confirmed the world-wide success of the European joint guidelines concept and the ability and strength of the European Society of Hypertension and the European Society of Cardiology to work together.

In 2013 European Hypertension Guidelines were again reconsidered, and the 2 Societies again developed a joint task force. In analogy with the previous Guidelines, the 2013 guidelines are evidence based and furthermore, for the first time, the level of evidence is provided for diagnostic methods and treatment recommendations. Importantly, the 2013 recommendations are updated with relevant research and recent outcome studies. The risk score algorithm is harmonized with the SCORE risk assessments which over the years have been used by ESC. Thus, the level of BP severity has been maintained and also the risk levels for intervention, which are translated into treatment recommendations. The hexagon for drug treatment, which essentially forms the logo of the European Hypertension Guidelines, has been maintained with some important modifications: Solid lines indicating recommended combinations are marked from thiazid diurtics to ARBs, ACEIs and CCBs, but the line between ARBs and ACEIs has got a red flag as warning against dual RAAS blockade. Beta-blockers are still within the hexagon but alpha-blockers have been substituted with “other antihypertensive drugs”.

Emphasis on detecting target organ damage is further highlighted and ambulatory and home BPs are more strongly recommended as supplementary methods to office BP measurements.

Furthermore, and for the first time, hypertension guidelines includes a figure ranging the level of evidence and describes the markers of end organ damage that should be followed for assessment of normalization during treatment. The strongest evidence in this respect, is in support of following left ventricular hypertrophy by echocardiography, which should normalize within 6-12 months. However, following ECG-LVH for normalization could also be useful.

BP targets during treatment are slightly less aggressive than previously; in most cases a target BP  140/90 mmHg is sufficient and according to what has been proven in outcome studies. BP should be treated in old people but with a slightly less aggressive target BP. High BP in young people needs work-up and consideration about possible treatment. A new section is on high BP during exercise, which carries strong prognostic information and should lead to further work-up including measurements of ambulatory BP for possible established hypertension. Also many more refinements and updates of the Guidelines text are included in the 2013 European Guidelines which will contribute to a successful acceptance and implementation of the new guidelines in clinical practice. They were published online in Journal of Hypertension and European Heart Journal on June 14 just prior to press conference and plenary presentation at the 23rd European Hypertension Meeting in Milan and is now also published in Blood Pressure which is also a journal endorsed by the European Society of Hypertension.

Practical Guidelines, a shortened version, will soon be developed and also published in all journals endorsed by the ESH and/or ESC.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.