Hypertension, or high blood pressure, is a common health condition. It occurs when blood pushes too forcefully against artery walls. Uncontrolled, it can lead to serious health problems like heart disease, stroke, kidney disease, and dementia. Medical guidelines for managing hypertension are regularly updated to incorporate research and improve care. The 2023 updates provide refined approaches to diagnosis and treatment.
How Hypertension is Diagnosed
Diagnosing hypertension involves assessing blood pressure readings. Systolic pressure is the force when your heart beats, while diastolic pressure is the force when it rests between beats.
Diagnosis typically requires a threshold of 140/90 mmHg or higher, as recommended by the European Society of Hypertension (ESH) guidelines. However, a single high reading is insufficient for diagnosis. Healthcare providers confirm hypertension with multiple measurements on different occasions.
Measurements can be taken in several ways. Office measurements are taken in a clinical setting. Home blood pressure monitoring (HBPM) allows readings in one’s own environment. Ambulatory blood pressure monitoring (ABPM) involves a portable device measuring blood pressure over 24-48 hours, including during sleep and daily activities. Both HBPM and ABPM help identify “white coat hypertension” (high readings only in a clinical setting) and “masked hypertension” (normal readings in the office but high at home).
Current Treatment Strategies
Hypertension management involves lifestyle adjustments and, if needed, medication. Lifestyle changes are often the first step, recommended for all with elevated blood pressure. They aim to reduce blood pressure and improve cardiovascular health.
Dietary changes, like the DASH (Dietary Approaches to Stop Hypertension) diet, play a significant role. The DASH diet emphasizes fruits, vegetables, whole grains, lean protein, and low-fat dairy, while limiting saturated and trans fats, cholesterol, and sodium. Regular physical activity (e.g., 150 minutes of moderate exercise per week) also lowers blood pressure. Maintaining a healthy weight, limiting alcohol, and stopping smoking further impact blood pressure control.
If lifestyle changes are insufficient, medication is prescribed. Medication classes include ACE inhibitors, angiotensin receptor blockers (ARBs), calcium channel blockers, and diuretics. Often, a combination of two drug classes is recommended as initial therapy for better control. Medication and dosage are tailored to the individual, considering age, other health conditions, and tolerance.
Treatment goals vary. For many adults, especially those at high cardiovascular risk, a goal of less than 130/80 mmHg is often recommended. However, targets may be adjusted for certain populations, such as older adults or those with chronic kidney disease, where slightly higher targets might be considered.
What’s New in the 2023 Guidelines
The 2023 European Society of Hypertension (ESH) guidelines offer updates for managing hypertension. While largely resembling the 2018 European Society of Cardiology/ESH guidelines, changes are incremental. A notable emphasis is on out-of-office blood pressure measurements (home and ambulatory monitoring) for diagnosis and management. These methods provide a more accurate reflection of typical blood pressure.
The 2023 ESH guidelines maintain a diagnostic threshold of 140/90 mmHg or higher, contrasting with the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines’ lower threshold of 130/80 mmHg or higher. Consequently, ESH’s “high-normal” blood pressure (systolic 130-139 mmHg or diastolic 85-89 mmHg) is considered “stage 1 hypertension” by ACC/AHA criteria.
Treatment targets in the 2023 ESH guidelines are age-based. For adults 18-64, the ESH suggests a target of less than 130/80 mmHg, similar to ACC/AHA. For individuals 65-79, ESH recommends less than 140/80 mmHg, or less than 130/80 mmHg if well-tolerated. For adults 80 and older, a systolic target between 140 and 150 mmHg is advised. This differs from ACC/AHA, which generally recommends a uniform target of less than 130/80 mmHg for most patients, regardless of age.
Updated recommendations also cover specific populations. This includes more explicit advice for managing hypertension in children and adolescents. For adolescents 16 or older, diagnostic and treatment criteria align with adults, targeting less than 140/90 mmHg. New recommendations also cover chronic kidney disease management, including specific medications like SGLT-2 inhibitors and finerenone. Additionally, ESH guidelines discuss renal denervation as an additional or alternative therapy for uncontrolled resistant hypertension, a recommendation not found in ACC/AHA.
What the Guidelines Mean for You
Understanding updated hypertension guidelines empowers you to engage in your healthcare. They provide a framework for providers to diagnose and manage high blood pressure, and a resource for you to comprehend treatment goals. Staying informed allows for more meaningful conversations with your doctor about your readings and treatment plan.
Always discuss your blood pressure measurements and concerns with your healthcare provider. Your doctor considers your overall health, other medical conditions, and lifestyle to determine the best diagnostic and treatment approach. This personalized approach ensures guidelines suit your unique circumstances.
Adhering to your prescribed treatment plan, including lifestyle changes or medication, is important for effective blood pressure management. Regular blood pressure monitoring, both at home and during office visits, helps track progress and allows for timely treatment adjustments. Guidelines guide clinical decisions but are not rigid rules; your individual health journey is unique, and collaborative decision-making with your healthcare team is central to optimal health outcomes.