European guidelines for managing high blood pressure

The European Society of Hypertension and the European Society of Cardiology summarised guidelines for managing high blood pressure. 

Hypertension (high blood pressure) is a common medical condition where pressure in the blood vessels is too high. Uncontrolled high blood pressure causes the heart of have to work harder in order to pump blood against the pressure in the arteries. Over time, this added workload on the heart can cause the heart to weaken and lead to abnormal heart rhythm, heart attack, or sudden loss of heart function (cardiac arrest). Therefore, correct management of high blood pressure is vital. 

This study summarised ideal blood pressure targets, lifestyle modifications and antihypertensive drugs (drugs to reduce high blood pressure) for treating high blood pressure according to recent trials and studies. 

1. Ideal blood pressure targets

This study recommended that all patients treated for high blood pressure should aim to achieve a systolic blood pressure of <140 mmHg. Systolic blood pressure (SBP) is the pressure inside arteries when the heart is contracting. SBP is the top number when blood pressure is measured. Diastolic blood pressure (DBP) should be <90 mmHg. DBP is the pressure inside arteries when the heart is relaxed, or the bottom number on blood pressure readings.

However, for those with diabetes, the committee recommend that a diastolic blood pressure (DBP) of <85 mmHg should be reached. 

In the elderly, the SBP target should be between 140-150 mmHg but can be lower than this if the person is fit and healthy. Blood pressure should not exceed 140/90 mmHg as this increases the risk of heart disease and stroke.

2.  Lifestyle changes

Lifestyle guidelines to reduce blood pressure include restricting salt intake to 5-6g per day, reducing body-mass index (BMI) to 25 kg/m², reducing waist circumferences to <102 cm in men and <88 cm in women, stop smoking, regular physical exercise, moderate alcohol consumption (<140g of ethanol per week for men and <80g per week for women) and a high consumption of vegetables and fruits and low-fat dairy foods. 

3. Antihypertensive drugs (drugs that reduce high blood pressure)

The study recommended that drug therapy for high blood pressure should be adjusted to the patient's overall risk for heart disease e.g. if they have other diseases, a family history of heart disease, if they have organ damage, and their lifestyle.

Single therapy (taking only 1 type of antihypertensive drug) is recommended for individuals with low or moderate risk for heart disease and mildly elevated blood pressure. Drugs recommended for single therapy include diuretics e.g. chlorthalidone (Diuril), beta-blockers e.g. carvedilol (Coreg), calcium blockers e.g. amlodipine (Norvasc), ACE inhibitors e.g. Ramipril (Altace), and angiotensin receptor blockers (ARBs) e.g. Azilsartan (Edarbi).

Individuals with a high risk of heart disease or significantly high blood pressure should start with combination therapy, which means taking two or more antihypertensive drugs as this allows control over blood pressure more rapidly. Recommended combination therapy included thiazide diuretics with either ARBs, calcium blockers, or ACE inhibitors; or calcium blockers combined with diuretics, ARBs, or ACE inhibitors. Combining ARBs and ACE inhibitors is not recomennded due to health concerns.

These guidelines suggest that important lifestlye changes and personalised treatment strategy help achieve normal blood pressure. 

These guidelines are suggestions rather than strict rules. 

If you or someone you know have high blood pressure, discuss with a doctor the new recommended guidelines for normal blood pressure.