Author + information
- Received March 4, 2019
- Accepted March 26, 2019
- Published online June 10, 2019.
- aDepartment of Medicine, AHA Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, University of Chicago Medicine, Chicago, IllinoisDepartment of Medicine, AHA Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, University of Chicago Medicine, Chicago, Illinois
- bDepartment of Medicine and Surgery, University of Milano-Bicocca and Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, Milan, ItalyDepartment of Medicine and Surgery, University of Milano-Bicocca and Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, Milan, Italy
- ↵∗Address for correspondence:
Dr. George Bakris, AHA Comprehensive Hypertension Center, University of Chicago Medicine, 5841 S. Maryland Avenue, MC 1027, Chicago, Illinois 60637.
• Blood pressure guidelines are updated as new data from clinical trials emerge.
• The 2018 ACC/AHA and ESC/ESH guidelines interpreted similar data with a fundamental difference of 2 different blood pressure goals: <130/80 mm Hg for ACC/AHA and <140/90 mm Hg for ESC/ESH.
• Other differences include the approach to assess risk and goals in older people at 130/70 to 139/79 mm Hg for ESC/ESH but <130/80 mm Hg for ACC/AHA.
• Guideline implementation should include patient participation and cooperation. This is a large part of the ESC/ESH guideline and mentioned but not emphasized in the ACC/AHA guideline.
This study compares the recommendations of the most recent American College of Cardiology (ACC)/American Heart Association (AHA) and European Society of Cardiology (ESC)/European Society of Hypertension (ESH) blood pressure guidelines. Both guidelines represent updates of previous guidelines and reinforce previous concepts of prevention regarding elevated blood pressure. Specifically, a low-sodium diet, exercise, body weight reduction, low to moderate alcohol intake, and adequate potassium intake are emphasized. Overall, both guidelines agree on the proper method of blood pressure measurement, the use of home blood pressure and ambulatory monitoring, and restricted use of beta-blockers as first-line therapy. The major disagreements are with the level of blood pressure defining hypertension, flexibility in identifying blood pressure targets for treatment, and the use of initial combination therapy. Although initial single-pill combination therapy is strongly recommended in both guidelines, the ESC/ESH guideline recommends it as initial therapy in patients at ≥140/90 mm Hg. The ACC/AHA guideline recommends its use in patients >20/10 mm Hg above blood pressure goal. Thus, the only real disagreement is that the ACC/AHA guidelines maintain that all people with blood pressure >130/80 mm Hg have hypertension, and blood pressure should be lowered to <130/80 mm Hg in all. In contrast, the ESC/ESH guidelines state that hypertension is defined as >140/90 mm Hg, with the goal being a level <140/90 mm Hg for all targeting to <130/80 mm Hg only in those at high cardiovascular risk, but always considering individual tolerability of the proposed goal.
Dr. Bakris is a consultant for Merck, Vascular Dynamics, Bayer, and Novo Nordisk; is a member of the steering committees of CREDENCE (Janssen) and CALM-2 (Vascular Dynamics); and is principal investigator of the FIDELIO trial (Bayer). Dr. Parati has received honoraria for lectures from Pfizer, Sanofi, and Omron HealthCare. Dr. Ali has reported that he has no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received March 4, 2019.
- Accepted March 26, 2019.
- 2019 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.