In a commentary authored by Whelton et al., the 2023 European Society of Hypertension (ESH) Guidelines for the management of arterial hypertension present incremental adjustments compared to the 2018 version. Although aimed at European practitioners, they align with global blood pressure (BP) guidelines. Despite numerous guidelines, global surveys show poor implementation of BP recommendations. The guidelines stress the need for improved diagnosis and management, urging a focus on implementation science.
Key aspects include 22 sections covering diverse diagnostic and management aspects, with notable recommendations for out-of-office BP measurements, potassium supplementation, and explicit advice on beta blockers. The guidelines also address cognitive decline prevention through antihypertensive therapy.
The prevalence of hypertension in Europe is around 39% in men and 35.7% in women. The guidelines suggest drug therapy for individuals with an average systolic BP of 130 to 139 mmHg or diastolic BP of 80 to 89 mmHg at a higher threshold of cardiovascular disease (CVD) risk compared to American guidelines.
Implementation of BP guideline recommendations is a global concern, with the United States showing declining rates influenced by conflicting guidelines and the COVID-19 pandemic. The prevalence of hypertension varies globally, with high rates in Europe. Accurate cuffless wearables may improve implementation if clinically validated.
The author stressed the urgency for BP clinical practice guidelines to prioritize implementation as current practices show suboptimal prevention, diagnosis, and treatment of hypertension. Below are some of the suggested strategies for better implementation:
- Precision in Blood Pressure Measurement
Ensure accuracy through the use of clinically validated blood pressure measurement devices - Health Promotion
Emphasize initiatives to promote overall health and well-being - Accessible Community-Based Healthcare
Facilitate easy access to healthcare services within local communities - Knowledgeable Patient-Centered Healthcare Team
Foster a healthcare team that is well-informed and prioritizes patient-centered care - Evidence-Based Protocols
Implement straightforward, evidence-based protocols for counseling on lifestyle changes and administering antihypertensive drug treatments in patients with uncomplicated hypertension - Reliable Access to Medications
Ensure consistent access to effective and affordable antihypertensive medications, with a preference for using single-pill combinations for combination drug therapies - Information Systems for Progress Tracking
Employ information systems to monitor and manage progress, facilitating efficient case management
In summary, the 2023 ESH guidelines emphasize incremental changes and recommendations for improved hypertension management globally. The commentary underscored the challenge of implementing BP guidelines and calls for effective strategies, including innovative treatment approaches and user-friendly guidelines.
BP: blood pressure; COVID-19: coronavirus disease of 2019; CVD: cardiovascular disease; ESH: European Society of Hypertension
Link to the full commentary: https://www.ahajournals.org/doi/epub/10.1161/HYPERTENSIONAHA.123.21592
Reference: Whelton PK, Flack JM, Jennings G, Schutte A, Wang J, Touyz RM. Editors’ Commentary on the 2023 ESH Management of Arterial Hypertension Guidelines. Hypertension. 2023;80(9):1795-1799. doi:10.1161/HYPERTENSIONAHA.123.21592
Link to the 2023 ESH Guidelines: https://journals.lww.com/jhypertension/fulltext/2023/12000/2023_esh_guidelines_for_the_management_of_arterial.2.aspx
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