aUniversity of Milano-Bicocca, Ospedale San Gerardo, Milan, ItalybDepartment of Public Health, University Hospital, Ghent, BelgiumcUniversity of Glasgow, Glasgow, UKdInstitute for Clinical Experimental Medicine, Prague, Czech RepubliceCatholic University, Leuven, BelgiumfUniversity La Sapienza, Policlinico Umberto 1, Roma, ItalygUniversity of Milano-Bicocca, San Gerardo Hospital, Milan, ItalyhUniversity of Manchester, Manchester, UKiUllevaal University Hospital, Oslo, NorwayjPharmacology Department, Hopital Europeen Georges Pompidou, Paris, FrancekDepartment of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, PolandlHospital 12 de Octubre, Madrid, SpainmDepartment of Cardiology, Medical University of Gdansk, Gdansk, PolandnMedizinische Klinik, University Erlangen Nuernberg, Erlangen, GermanyoDept. of Pharmacology, University of Limburg in Maastricht, Maastricht, The NetherlandspUniversity of Milan, Istituto Auxologico Italiano, Milan, Italy
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These practice guidelines on the management of arterial hypertension are a concise summary of the more extensive ones prepared by a Task Force jointly appointed by the European Society of Hypertension and the European Society of Cardiology.These guidelines have been prepared on the basis of the best available evidence on all issues deserving recommendations; their role must be educational and not prescriptive or coercive for the management of individual subjects who may differ widely in their personal, medical and cultural characteristics.The members of the Task Force have participated independently in the preparation of these guidelines, drawing on their academic and clinical experience and by objective examination and interpretation of all available literature. A disclosure of their potential conflict of interest is reported on the websites of the ESH and the ESC.1. Definition and classification of hypertensionBlood pressure has a unimodal distribution in the population as well as a continuous relationship with CV risk.For practical reasons the term “hypertension” is used in daily practice and patients are categorized as shown in Table 1. However the real threshold for defining “hypertension” must be considered as flexible, being high or low based on the total CV risk of each individual.2. Total cardiovascular (CV) riskAll patients should be classified not only in relation to the grades of hypertension but also in terms of the total CV risk resulting from the coexistence of different risk factors, organ damage and disease.Decisions on treatment strategies (initiation of drug treatment, BP threshold and target for treatment, use of combination treatment, need of a statin and other non-antihypertensive drugs) all importantly depend on the initial level of risk.There are several methods by which total CV risk can be assessed, all with advantages and limitations. Categorization of total risk as low, moderate, high, and very high added risk has the merit of simplicity and can therefore be recommended. The term ‘added risk’ refers to the risk additional to the average one.Total risk is usually expressed as the absolute risk of having a CV event within 10 years. Because of its heavy dependence on age, in young patients absolute total CV risk can be low even in the presence of high BP with additional risk factors. If insufficiently treated, however, this condition may lead to a partly irreversible high risk condition years later. In younger subjects treatment decisions should better be guided by quantification of relative risk, i.e. the increase in risk in relation to average risk in the population.Using rigid cut-offs of absolute risk (e.g. > 20% within 10 years) in order to decide on treatment is discouraged.3. Stratification of total CV riskIn the Figure 1 total CV risk is stratified in four categories. Low, moderate, high and very high risks refer to 10 year risk of a fatal or non-fatal CV event. The term “added” indicates that in all categories risk is greater than average. The dashed line indicates how the definition of hypertension (and thus the decision about the initiation of treatment) is flexible, i.e. may be variable depending on the level of total CV risk.4. Clinical variables that should be used to stratify total CV risk5. Diagnostic evaluation5.1 AimsEstablishing BP valuesIdentifying secondary causes of hypertensionSearching forother risk factors;subclinical organ damage;concomitant diseases;accompanying CV and renal complications.5.