Hypertension - historical perspective, landmark trails, measurement of hypertension, management of hypertension according to ESC/EHS 2018 guidelines

2. Disclosures
None

4. hard pulse disease
Ebers Papyrus

5. 1733- Stephen Hales
1905- Nikolai Korotkoff

6. 1910 and 1914
• Non-pharmacologic methods
• Hexamethonium, hydralazine and reserpine

7. 1950
1960

19. Body habitus:
Signs of HMOD:

20. Secondary hypertension:

23. Treatment of Hypertension

28. Class of recommendation 1, level of evidence A
Salt restriction to <5 g per day is
Recommended.
It is recommended to restrict alcohol
consumption
to:
• Less than 14 units per week for men.
• Less than 8 units per week for women
consumption of vegetables, fresh fruits,
fish, nuts, and unsaturated fatty acids
(olive oil); low consumption of red meat;
and consumption of low-fat dairy
products are recommended.
Regular aerobic exercise (e.g. at least 30
min of moderate dynamic exercise on
5–7 days per week)
Body-weight control is indicated to
avoid
obesity (BMI >30 kg/m2 or waist
circumference
>102 cm in men and >88 cm in
women), as is aiming at healthy BMI
(about
20–25 kg/m2) and waist circumference
values
(<94 cm in men and <80 cm in women)
to reduce BP and CV risk.

30. Pharmacological therapy for
hypertension

31. Among all antihypertensive drugs, ACE inhibitors,
ARBs, beta-blockers, CCBs, and diuretics (thiazides
and thiazide-like drugs such as chlorthalidone and
indapamide) have demonstrated effective reduction
of BP and CV events in RCTs, and thus are indicated as
the basis of antihypertensive treatment strategies
Combination treatment is recommended for most
hypertensive patients as initial therapy. Preferred
combinations shouldcomprise a RAS blocker (either
an ACE inhibitor or an ARB) with a CCB or diuretic.
Other combinations of the five majoclasses can be
used
It is recommended that beta-blockers are combined
with any of the other major drug classes when
thereare specific clinical situations, e.g. angina, post-
myocardial infarction, heart failure, or heart rate
control
It is recommended that if BP is not controlled with a
two-drug combination, treatment should be
increased to a three-drug combination, usually a RAS
blocker with a CCB and a thiazide/thiazide-like
diuretic, preferably as an SPC.
Class 1
Level A

41. Class III, Level B

42. Hypertension in specific circumstances

43. • Definition:
Pseudo-resistant hypertension :

50. Less than 18years:
• Renal parenchymal disease
• Coarctation of the aorta
• Monogenic disorders
Young adults (19–40 years):
• Renal parenchymal disease
• Fibromuscular dysplasia (especially in women)
• Undiagnosed monogenic disorders
Middle-aged adults (41–65 years):
• Primary aldosteronism
• Obstructive sleep apnoea
• Cushing’s syndrome
• Phaeochromocytoma
• Renal parenchymal disease
• Atherosclerotic renovascular disease
Older adults (>65 years):
• Atherosclerotic renovascular disease
• Renal parenchymal disease
• Thyroid disease

51. Common tests for all potential causes:

55. Class I, Level B:
Class I, Level C:

56. Class I, Level C:

57. Class III, Level C:

58. Antihypertensive drug treatment is
recommended
for people with diabetes when
office BP is >_140/90 mmHg
In people with diabetes receiving BP-
lowering drugs it is recommended:
To target SBP to 130 mmHg and <130mmHg
if tolerated, but not <120 mmHg
In older people (aged >_65 years aged), to
target to an SBP range of 130–139 mmHg.
It is recommended to initiate treatment with
a combination of a RAS blocker with a CCB
or thiazide/thiazide-like diuretic.
Class I
Level A

59. Class I, Level C:
Class III, LevelA: