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REFLECTIONS
Hypertension
Hypertension Global Newsletter #5 2023

GUIDELINES Hypertension

2023 ESH Guidelines for the management of arterial hypertension. The Task
Force for the Management of Arterial Hypertension of the European Society
of Hypertension endorsed by the European Renal Association (ERA) and the
International Society of Hypertension (ISH).
Mancia G, et al. J Hypertens. 2023 Jun 21. doi: 10.1097/HJH.0000000000003480. Online ahead of print.

Five years after the ESH-ESC Guidelines, the European Society of Hypertension (ESH), together with ISH (International Society
of Hypertension), clarifies several points; particularly, they provide clear advice on how to measure blood pressure, an upgraded
position for beta-blockers in the treatment algorithms, a new definition and treatment recommendations for ‘true resistant
hypertension’, and detail the management of hypertension in a number of special populations, including for the first time essential
recommendations on hypertension in children, adolescents, and the transition to young hypertensive adults individuals.

The correct measurement of blood pressure is of key importance in the management of hypertension and the new guidelines
upgrade recommendations regarding the use of out-of-hospital BP measurements, and include a detailed algorithm on how to
measure BP both at home and in the office.

Recommendations for BP measurements in the office and at home

The new guidelines try to simplify blood pressure targets by recommending a SBP of less than 140 mmHg for almost all patients.
Previously, there were different targets for different groups of patients depending on comorbidities or age. If drug treatment is well-
tolerated, treated SBP values should be targeted to 130 mmHg or lower in most patients up to 79 years old. Lowering SBP to below
120 mmHg is discouraged. In patients at least 80 years old who are not frail, the first objective of antihypertensive treatment is to
lower BP below 150/80 mmHg. However, a SBP target range between 130–139 mmHg may be considered, if well-tolerated. In very
frail patients, treatment targets should be individualized.

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