2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)
Abstract
Table of Contents Introduction Principles New aspects Epidemiological aspects Relationship of blood pressure to cardiovascular and renal damage Definition and classification of hypertension Prevalence of hypertension Hypertension and total cardiovascular risk Assessment of total cardiovascular risk Limitations Summary of recommendations on total cardiovascular risk assessment Diagnostic evaluation Bood pressure measurement Office or clinic blood pressure Out-of-office blood pressure White-coat (or isolated office) hypertension and masked (or isolated ambulatory) hypertension Clinical indications for out-of-office blood pressure Blood pressure during exercise and laboratory stress Central blood pressure Medical history Physical examination Summary of recommendations on blood pressure measurement, history, and physical examination Laboratory investigations Genetics Searching for asymptomatic organ damage Heart Blood vessels Kidney Fundoscopy Brain Clinical value and limitations Summary of recommendations on the search for asymptomatic organ damage, cardiovascular disease, and chronic kidney disease Searching for secondary forms of hypertension Treatment approach Evidence favouring therapeutic reduction of high blood pressure When to initiate antihypertensive drug treatment Recommendations of previous Guidelines Grade 2 and 3 hypertension and high-risk grade 1 hypertension Low-to-moderate risk, grade 1 hypertension Isolated systolic hypertension in youth Grade 1 hypertension in the elderly High normal blood pressure Summary of recommendations on initiation of antihypertensive drug treatment Blood pressure treatment targets Recommendations of previous Guidelines Low-to-moderate risk hypertensive patients Hypertension in the elderly High-risk patients The ‘lower the better’ vs. the J-shaped curve hypothesis Evidence on target blood pressure from organ damage studies Clinic vs. home and ambulatory blood pressure targets Summary of recommendations on blood pressure targets in hypertensive patients Treatment strategies Lifestyle changes Salt restriction Moderation of alcohol consumption Other dietary changes Weight reduction Regular physical exercise Smoking cessation Summary of recommendations on adoption of lifestyle changes Pharmacological therapy Choice of antihypertensive drugs Monotherapy and combination therapy Summary of recommendations on treatment strategies and choice of drugs Treatment strategies in special conditions White-coat hypertension Masked hypertension Summary of recommendations on treatment strategies in white-coat and masked hypertension Elderly Summary of recommendations on antihypertensive treatment strategies in the elderly Young adults Women Oral contraceptives Hormone replacement therapy Pregnancy Long-term cardiovascular consequences in gestational hypertension Summary of recommendations on treatment strategies in hypertensive women Diabetes mellitus Summary of recommendations on treatment strategies in patients with diabetes Metabolic syndrome Summary of recommendations on treatment strategies in hypertensive patients with metabolic syndrome Obstructive sleep apnoea Diabetic and non-diabetic nephropathy Summary of recommendations on therapeutic strategies in hypertensive patients with nephropathy Chronic kidney disease stage 5D Cerebrovascular disease Acute stroke Previous stroke or transient ischaemic attack Cognitive dysfunction and white matter lesions Summary of recommendations on therapeutic strategies in hypertensive patients with cerebrovascular disease Heart disease Coronary heart disease Heart failure Atrial fibrillation Left ventricular hypertrophy Summary of recommendations on therapeutic strategies in hypertensive patients with heart disease Atherosclerosis, arteriosclerosis, and peripheral artery disease Carotid atherosclerosis Increased arterial stiffness Peripheral artery disease Summary of recommendations on therapeutic strategies in hypertensive patients with atherosclerosis, arteriosclerosis, and peripheral artery disease Sexual dysfunction Resistant hypertension Carotid baroreceptor stimulation Renal denervation Other invasive approaches Follow-up in resistant hypertension Summary of recommendations on therapeutic strategies in patients with resistant hypertension Malignant hypertension Hypertensive emergencies and urgencies Perioperative management of hypertension Renovascular hypertension Primary aldosteronism Treatment of associated risk factors Lipid-lowering agents Antiplatelet therapy Treatment of hyperglycaemia Summary of recommendations on treatment of risk factors associated with hypertension Follow-up Follow-up of hypertensive patients Follow-up of subjects with high normal blood pressure and white-coat hypertension Elevated blood pressure at control visits Continued search for asymptomatic organ damage Can antihypertensive medications be reduced or stopped? Improvement of blood pressure control in hypertension Hypertension disease management Team approach
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In the 2008 ESH HBPM recommendations, a threshold for hypertension diagnosis with systolic/diastolic HBP of 135/85 mmHg was proposed, based on a review of evidence including two meta-analyses.
“In the 2008 ESH HBPM recommendations, a threshold for hypertension diagnosis with systolic/diastolic HBP of 135/85 mmHg was proposed [4], based on the review of evidence including two meta-analyses [139,140]”
Antiadrenergic drugs, coupled with diuretics and direct-acting vasodilators such as hydralazine, became the preferred antihypertensive therapy for thirty years.
“Antiadrenergic drugs, coupled with diuretics and direct-acting vasodilators such as hydralazine became the preferred antihypertensive therapy for thirty years115.”
From The Sympathetic Nervous System Alterations in Human Hypertension (2015) · cites this paper as [115]
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- Authors
- Mancia, G., Fagard, R., Narkiewicz, K., Redón, J., Zanchetti, A., Böhm, M., Christiaens, T., Cifkova, R., De Backer, G., Dominiczak, A., Galderisi, M., Grobbee, D. E., Jaarsma, T., Kirchhof, P., Kjeldsen, S. E., Laurent, S., Manolis, A. J., Nilsson, P. M., Ruilope, L. M., Schmieder, R. E., Sirnes, P. A., Sleight, P., Viigimaa, M., Waeber, B., & Zannad, F.
- Affiliations
- KU Leuven (BE)
- National LGBTQ Task Force (US)
- Corresponding author
- Mancia, Giuseppe
- Fagard, Robert
- ORCID
- Mancia, Giuseppe
- Narkiewicz, Krzysztof
- Redón, Josep
- Zanchetti, Alberto
- Böhm, Michael
- Dominiczak, Anna
- Galderisi, Maurizio
- Grobbee, Diederick E.
- Jaarsma, Tiny
- Kirchhof, Paulus
- Kjeldsen, Sverre E.
- Laurent, Stéphane
- Manolis, Athanasios J.
- Nilsson, Peter M.
- Ruilope, Luis Miguel
- Schmieder, Roland E.
- Sirnes, Per Anton
- Viigimaa, Margus
- Zannad, Faiez
- Venue
- Journal of Hypertension
- Published
- 2013-07
- Volume
- 31
- Issue
- 7
- Pages
- 1281-1357
- ISSN
- 0263-6352 (ISSN-L)
- OpenAlex
- W2167557672
- Cited by
- 5,655
- References
- 122
- Citations by year
- 2026: 33 · 2025: 63 · 2024: 120 · 2023: 137 · 2022: 158 · 2021: 208 · 2020: 248 · 2019: 341 · 2018: 606 · 2017: 635 · 2016: 679 · 2015: 612 · 2014: 617 · 2013: 301 · 2012: 205
- FWCI
- 500.99
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Hypertension (publishedVersion)
- PubMed (publishedVersion)
- ABACUS. Repositorio de Producción Científica (Universidad Europea) (submittedVersion)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion)
- BOA (University of Milano-Bicocca) (submittedVersion)
- Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion)
- Institutional Research Information System University of Ferrara (University of Ferrara) (submittedVersion)
- IRIS (submittedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- SERVAL (Université de Lausanne) (submittedVersion)
- Funders
- Univerzita Karlova v Praze
- Università degli Studi di Milano
- University of Glasgow
- Institut National de la Santé et de la Recherche Médicale
- Lunds Universitet
- Universitat de València
- KU Leuven
- Universiteit Gent
- Universitetet i Oslo
- Tallinna Tehnikaülikool
- Centre Hospitalier Universitaire Vaudois
- Istituto Auxologico Italiano
- INCLIVA Instituto de Investigación Sanitaria
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Keywords
- hypertension, antihypertensive therapy, cardiovascular risk assessment, blood pressure measurement, white coat hypertension, masked hypertension, blood pressure targets, lifestyle modification, salt restriction, combination antihypertensive therapy, hypertension in pregnancy, gestational hypertension, hypertension in diabetes, metabolic syndrome, obstructive sleep apnea, diabetic nephropathy, chronic kidney disease, cerebrovascular disease, cognitive impairment
- MeSH terms
- Adult, Aged, Antihypertensive Agents, Europe, Female, Humans, Hypertension, Life Style, Male, Middle Aged, Young Adult
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