1st June 2007
European Society of Cardiology
European Society of Hypertension
Summary, Abstract,

Source: National Guidelines Clearinghouse

GUIDELINE OBJECTIVE(S)

• To offer the best available and most balanced recommendation to all health care providers involved in the management of hypertension
• To provide guidelines that have been prepared on the basis of the best available evidence on all issues deserving recommendations, and with the consideration that guidelines should have an educational purpose more than a prescriptive one

TARGET POPULATION

Patients with hypertension

INTERVENTIONS AND PRACTICES CONSIDERED

Diagnosis

1. Repeated blood pressure (BP) measurements
2. Medical history
3. Physical examination for evidence of additional risk factors (in particular abdominal obesity), for signs suggesting secondary hypertension, and for evidence of organ damage
4. Laboratory and instrumental investigations
   • Fasting plasma glucose
   • Serum total cholesterol
   • Serum low density lipoprotein (LDL)-Cholesterol
   • Serum high density lipoprotein (HDL)-cholesterol
   • Fasting serum triglycerides
   • Serum uric acid
   • Serum creatinine
   • Serum potassium
   • Estimated creatine clearance (Cockroft-Gault formula) or glomerular filtration rate (Modification of Diet in Renal Disease formula)
   • Haemoglobin and haematocrit
   • Urinalysis (complemented by microalbuminuria via dipstick test and microscopic examination)
   • Electrocardiogram
5. Echocardiogram
6. Carotid ultrasound
7. Quantitative proteinuria (if dipstick positive)
8. Ankle-brachial BP index
9. Fundoscopy
10. Glucose tolerance test (if fasting plasma glucose >5.6 mmol/L (100 mg/dL)
11. Home and 24 hour ambulatory BP monitoring
12. Pulse wave velocity measurement (where available)
13. Searching for subclinical organ damage

Treatment

1. Lifestyle changes including smoking cessation, weight reduction, reduction of excessive alcohol intake, physical exercise, reduction of salt intake, and increase in fruit and vegetable intake and decrease in saturated and total fat intake
2. Calcium antagonists
3. Angiotensin-converting enzyme inhibitors
4. Thiazide diuretics
5. Beta blockers
6. Angiotensin receptor antagonist
7. Alpha-blockers
8. Monotherapy versus combination therapy
9. Treatment of associated risk factors
10. Patient follow up
11. Improvement of patient compliance
12. Management of hypertension in patient subgroups (elderly, diabetics, patients with renal dysfunction, cerebrovascular disease, coronary heart disease and heart failure, women)

MAJOR OUTCOMES CONSIDERED

• Total cardiovascular risk
• All-cause morbidity and mortality
• Left ventricular hypertrophy
• Presence of atherosclerosis