Nouvelle stratégie de prise en charge de l’hypertension en 2018 proposée par les sociétés européennes de cardiologie et d’hypertension Quoi de neuf et quelles différences avec les nouvelles directives américaines présentées en 2017 ?

New European guidelines for high blood pressure management have just been published in 2018, modifying those published in 2013 and may be seen as a response to those published by the American societies late 2017. The latter proposed a new definition of hypertension (blood pressure equal or higher than 130/80 mmHg), a therapeutic approach based on the evaluation of the cardiovascular risk, and a blood pressure target <130/80 mmHg in all patients, even those older than 80 years still valid. The European guidelines, on the contrary, maintain the definition threshold of hypertension to a blood pressure equal or higher than 140/90 mmHg. This diagnosis remains based on blood pressure determination at the medical office, confirmed if possible by the use of out of the clinic blood pressure measurements such as home blood pressure and/or 24h ambulatory blood pressure measurement. In comparison with 2013, these new guidelines are closer to the American ones for the management, with the need to evaluate the cardiovascular risk before deciding to initiate a drug treatment in addition to lifestyle and diet measures. A medical therapy will be initiated if the risk is very high for blood pressure in the range of high normal blood pressure (130-139/85-89 mmHg). The blood pressure target should be < 130/80 mmHg in people < 65 years. For those older the blood pressure target should be < 140 mmHg but > 120 mmHg. The antihypertensive therapy would be, in the majority of the population, a two-drug combination, if possible in a single pill to enhance the medication compliance that should be frequently checked. If the blood pressure lowering remains resistant to three drugs including a diuretic used at high dose, spironolactone would be recommended, at a low dose. In comparison with 2013, the device-based therapies (renal denervation) are no longer recommended. © 2018 Revue Medicale de Liege. All rights reserved.