Within the last 2 years, major guidelines have been issued from U.S.-based and European organizations that differ in their recommendations for the diagnosis and treatment of hypertension.
In 2017, the American College of Cardiology in United States issued new guidelines for hypertension. They are as follows:
In Europe, The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH), issued guidelines in Sept. 2018. They are as follows:
Upon the ESC release of the European Guidelines, the ACC issued a statement outlining key points (read here), including the following statement:
The European recommendations are generally more conservative regarding definitions, treatment thresholds, and treatment targets. The Europeans express concern with the randomized clinical trial data, suggesting the threshold for beginning drug therapy in high-risk patients at 130 mm Hg had a significant percentage of patients on antihypertensive therapy that was begun at higher pressures. And this would be a higher risk group who would prejudice to further benefit if the trial systolic BP (sBP) was <140 mm Hg.
Though the differences between the two guidelines are subtle, they do beg the question, which guidelines are preferred. In this podcast, experts from both sides of the Atlantic—Paul Whelton, M.D., from the United States (Tulane University, New Orleans, Louisiana) and Bryan Williams, M.D., from Europe (University College London in England)—discuss the similarities and differences in these guidelines and the basis for the differences. They were interviewed by JAMA editors Greg Curfman, M.D., and Ed Livingston, M.D.
Podcast – Battle of the Heart Societies: Who Is Right – the U.S. or Europe Regarding How to Manage Hypertension?