Interpretation of the 2018 ESC/ESH Guidelines for the Management of Arterial Hypertension

doi:10.12114/j.issn.1007-9572.2019.00.224

Abstract

Abstract: As the concept of prevention and treatment of cardiovascular diseases has gradually transferred from passive prevention to active prevention，hypertension，a primary risk factor for cardiovascular diseases，has been receiving more and more attention.The 2018 ESC/ESH Guidelines for the Management of Arterial Hypertension released at the 2018 European Society of Cardiology Congress was based on recent clinical evidence of the benefits of anti-hypertension treatment for cardiovascular diseases.Compared with the 2013 version，hypertension management and control have been significantly updated in the new guidelines，but some previous ideas are still being followed.The new guidelines comprehensively and detailedly elaborates the hypertension diagnosis，blood pressure measurement，risk stratification of hypertension，initiation of antihypertensive treatment，blood pressure treatment targets，hypertension treatment，and management of resistant and secondary hypertension，with efforts intensified in the prevention and control，in particular，the initiation time and threshold value for blood pressure-lowering drug treatment and initiation of drug combination.Besides，priority recommendation of single tablet regimen of fixed compound preparations，and concepts of blood pressure monitoring and comprehensive management in patients with hypertension，are also worthy of clinical reference and learning.

Key words: Hypertension, Guidebooks, General practitioners, Blood pressure measurement, Antihypertensive therapy

摘要： 随着心血管病的防治理念逐渐由被动防治转向主动预防，高血压作为心血管病的首要危险因素，也越来越受到重视，近年来有关降压治疗带来心血管病获益的临床循证医学证据不断积累，2018年欧洲心脏病学会年会上发布的《2018年欧洲高血压管理指南》，较《2013年欧洲高血压管理指南》在高血压的管控方面有较大更新，既沿用了以往的一些理念，又更新了许多新的内容，新版高血压管理指南在高血压诊断、血压测量、高血压的风险分层、降压治疗的启动时机、降压治疗的目标值变化、高血压的治疗、难治性高血压与继发性高血压的处理等方面均进行了全面而详细的阐述，其在高血压防控方面加大了力度，尤其在高血压的启动治疗时机、启动治疗的血压阈值、治疗药物的起始联合用药及对单片固定复方制剂的优先推荐以及高血压患者的血压监测及综合管理的治疗理念方面，值得临床借鉴与学习。

关键词: 高血压, 指南, 全科医生, 血压测量, 降压治疗

CHENG Wenli. Interpretation of the 2018 ESC/ESH Guidelines for the Management of Arterial Hypertension　[J]. Chinese General Practice, 2019, 22(21): 2519-2523. DOI: 10.12114/j.issn.1007-9572.2019.00.224.
程文立. 《2018年欧洲高血压管理指南》解读[J]. 中国全科医学, 2019, 22(21): 2519-2523. DOI: 10.12114/j.issn.1007-9572.2019.00.224.

References

［1］ETTEHAD D，EMDIN C A，KIRAN A，et al．Blood pressure lowering for prevention of cardiovascular disease and death：a systematic review and meta-analysis［J］．Lancet，2016，387（10022）：957-967．DOI：10.1016/S0140-6736（15）01225-8.
［2］WHELTON P K，CAREY R M，ARONOW W S，et al．2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention，detection，evaluation，and management of high blood pressure in adults：a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines［J］．J Am Coll Cardiol，2018，71（19）：e127-248．DOI：10.1016/j.jacc.2017.11.006.
［3］WILLIAMS B，MANCIA G，SPIERING W，et al．2018 ESC/ESH Guidelines for the management of arterial hypertension［J］．Kardiol Pol，2019，77（2）：71-159．DOI：10.5603/KP.2019.0018.
［4］MANCIA G，FAGARD R，NARKIEWICZ K，et al．2013 ESH/ESC practice guidelines for the management of arterial hypertension［J］．Blood Pressure，2014，23（1）：3-16．DOI：10.3109/08037051.2014.868629.
［5］MARGOLIS K L，ASCHE S E，BERGDALL A R，et al．Effect of home blood pressure telemonitoring and pharmacist management on blood pressure control：a cluster randomized clinical trial［J］．JAMA，2013，310（1）：46-56．DOI：10.1001/jama.2013.6549.
［6］MCMANUS R J，MANT J，HAQUE M S，et al．Effect of self-monitoring and medication self-titration on systolic blood pressure in hypertensive patients at high risk of cardiovascular disease：the TASMIN-SR randomized clinical trial［J］．JAMA，2014，312（8）：799-808．DOI：10.1001/jama.2014.10057.
［7］PICKERING T G，MILLER N H，OGEDEGBE G，et al．Call to action on use and reimbursement for home blood pressure monitoring：a joint scientific statement from the American Heart Association，American Society of Hypertension，and Preventive Cardiovascular Nurses Association［J］．Hypertension，2008，52（1）：10-29．DOI：10.1161/HYPERTENSIONAHA.107.189010.
［8］PIEPOLI M F，HOES A W，AGEWALL S，et al．2016 European Guidelines on cardiovascular disease prevention in clinical practice：the Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice （constituted by representatives of 10 societies and by invited experts）Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation （EACPR）［J］．Eur Heart J，2016，37（29）：2315-2381．DOI：10.1093/eurheartj/ehw106.
［9］AKTAS M K，OZDURAN V，POTHIER C E，et al．Global risk scores and exercise testing for predicting all-cause mortality in a preventive medicine program［J］．JAMA，2004，292（12）：1462-1468．DOI：10.1001/jama.292.12.1462.
［10］COONEY M T，DUDINA A L，GRAHAM I M.Value and limitations of existing scores for the assessment of cardiovascular risk：a review for clinicians［J］．J Am Coll Cardiol，2009，54（14）：1209-1227．DOI：10.1016/j.jacc.2009.07.020.
［11］BORGHI C，ROSEI E A，BARDIN T，et al．Serum uric acid and the risk of cardiovascular and renal disease［J］．J Hypertens，2015，33（9）：1729-1741；discussion 1741．DOI：10.1097/HJH.0000000000000701.
［12］THOMOPOULOS C，PARATI G，ZANCHETTI A.Effects of blood pressure-lowering on outcome incidence in hypertension：5.Head-to-head comparisons of various classes of antihypertensive drugs-overview and meta-analyses［J］．J Hypertens，2015，33（7）：1321-1341．DOI：10.1097/HJH.0000000000000614.
［13］KRONISH I M，WOODWARD M，SERGIE Z，et al．Meta-analysis：impact of drug class on adherence to antihypertensives［J］．Circulation，2011，123（15）：1611-1621．DOI：10.1161/CIRCULATIONAHA.110.983874.
［14］MENSAH G A，BAKRIS G.Treatment and control of high blood pressure in adults［J］．Cardiol Clin，2010，28（4）：609-622．DOI：10.1016/j.ccl.2010.08.002.
［15］Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic：the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial （ALLHAT）［J］．JAMA，2002，288（23）：2981-2997.
［16］DAHL?F B，DEVEREUX R B，KJELDSEN S E，et al．Cardiovascular morbidity and mortality in the Losartan Intervention for Endpoint reduction in hypertension study （LIFE）：a randomised trial against atenolol［J］．Lancet，2002，359（9311）：995-1003．DOI：10.1016/S0140-6736（02）08089-3.
［17］THOMOPOULOS C，PARATI G，ZANCHETTI A.Effects of blood-pressure-lowering treatment on outcome incidence.12.Effects in individuals with high-normal and normal blood pressure：overview and meta-analyses of randomized trials［J］．J Hypertens，2017，35（11）：2150-2160．DOI：10.1097/HJH.0000000000001547.
［18］NCD Risk Factor Collaboration.Worldwide trends in blood pressure from 1975 to 2015：a pooled analysis of 1479 population-based measurement studies with 19.1 million participants［J］．Lancet，2017，389（10064）：37-55．DOI：10.1016/S0140-6736（16）31919-5.

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