esh-esc ht guideline 2013

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ESC/ESH guideline 2013

ESC/ESH guideline 2013Dr atma gunawan(consultant of hypertension and nephrology)TheTask Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the EuropeanSociety of Cardiology (ESC)List of authors/Task Force Members: Giuseppe Mancia (Chairperson) (Italy), Robert Fagard (Chairperson) (Belgium), Krzysztof Narkiewicz (Section co-ordinator) (Poland), Josep Redon (Section co-ordinator) (Spain), Alberto Zanchetti (Section co-ordinator) (Italy), Michael Bo hm (Germany), Thierry Christiaens (Belgium), Renata Cifkova (Czech Republic), Guy De Backer (Belgium), Anna Dominiczak (UK), Maurizio Galderisi (Italy), Diederick E. Grobbee (Netherlands),Tiny Jaarsma (Sweden), Paulus Kirchhof (Germany/UK), Sverre E. Kjeldsen (Norway), Stephane Laurent (France), Athanasios J. Manolis (Greece), Peter M. Nilsson (Sweden), Luis Miguel Ruilope (Spain), Roland E. Schmieder (Germany), Per Anton Sirnes (Norway), Peter Sleight (UK), Margus Viigimaa (Estonia), Bernard Waeber (Switzerland), and Faiez Zannad (France)24 countries, 735 literature, within the last 6 yearsPrevious guideline : 2003 and 200724 countries, 735 literature. he 2013 guidelines on hypertension of the European Society of Hypertension (ESH) and the EuropeanSociety of Cardiology (ESC) follow the guidelines jointly issued by the two societies in 2003 and 2007 [1,2].Publication of a new document 6 years after the previous one2Levels of Evidence

Classes of recommendations

4Denitions and classication of office BP levels (mmHg)* CategorySystolicDiastolicOptimal32 cm) and thin arms, respectivelyCuff at the heart levelPhase I and V (disappearance) Korotkoff sounds to identify systolic and diastolic BPMeasure BP in both arms at first visit, take the arm with the higher value as the referenceIn elderly,diabetic, other conditions in which orthostatic hypotension may be frequent or suspected : at first visit measure BP 1 and 3 min after assumption of the standing BP, blood pressure.Who should measure BP ?

Mancia,et.al, Hypertension 1987;9;209Increase in systolic pressure, determined by continuous intra-arterial monitoring, in 30 hypertensive patients as the blood pressure is taken with a sphygmomanometer by an unfamiliar doctor or nurse. A new doctor's visit raised the systolic pressure by a mean of 22 mmHg within the first few minutes, an effect that attenuated within 5 to 10 minutes and that was less pronounced with a nurse's visit. The alerting effect of the new physician's visit persisted for four daily visits in this study but typically diminished with increasing familiarity. A similar pattern was seen with the diastolic pressure, with the peak increase being 13 mmHg during a physician's visit.7Variations in the measurement of blood pressure between doctors and nursesFrequency distribution of systolic blood pressureFrequency distribution of diastolic blood pressure

J. Roy. Coll. gen. Practit., 1971, 21, 698Circadian BP rhythm in normotensive (lower curve) and hypertensive (upper curve) individuals

Stylised representation of 24-hour blood pressure rhythm in normotensive (lower curve) and hypertensive (upper curve) individuals. The rectangle indicates period of maximum risk for cardiovascular events.Highest levels of blood pressure occur after 10 am with a peak around noon but often with a plateau extending to 6 pm.Leading up to this, there is a rise in pressure from the time of waking or before (about 6 am), with the pressure rising by up to 20/15 mmHg in most people.There is a decline in pressure of 10-20% in the late evening and on going to sleep, with a nadir in blood pressure at about 3 am.

Of course this can be modified by changes in patterns of activity, for instance in shift workers, and by other factors such as strenuous exercise and anxiety (as in the white-coat syndrome). This pattern is also modified in some hypertensive patients, who can experience:The loss of nocturnal 'dipping', that is to say the decline in blood pressure is less than 10% at night and may be almost non-existent. This is associated with increased target-organ damage and enhanced risk of cardiovascular events.[3,4] Extreme dipping, with reductions in pressure of more than 20% in night-time pressures. This too is thought to be harmful, especially with regard to stroke, but this has yet to be fully confirmed.[5] The morning rise or 'surge' in blood pressure may be exaggerated, not necessarily in the rate of rise in pressure but rather in the level attained.Broadly, changes in heart rate parallel those in blood pressure.

9Melatonin circadian

Blood pressure monitoringHome BP : measured at 7 AM and 7 PM, at least 3 days

ABPM (ambulatory blood pressure monitoring)

Definitions of hypertension by office and out-of-office BP levels CategorySystolic BP(mmHg)Diastolic BP(mmHg)Office BP140and90Ambulatory BPDaytime (or awake)135and/or85Nighttime (or asleep)120and/or7024-h130and/or80Home BP135and/or85BP, blood pressure.Medical Education & Information for all Media, all Disciplines, from all over the WorldPowered by2013 ESH/ESC Guidelines for the management of arterial hypertensionThe Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) - J Hypertension 2013;31:1281-1357White coat hypertension

Office BP persistently 140/90mmHgNormal daytime ambulatory (1.1 mV; Cornell voltage duration product >244 mV*ms), or Echocardiographic LVH [LVM index: men >115 g/m2; women >95 g/m2 (BSA)]a Carotid wall thickening (IMT >0.9 mm) or plaque Carotid-femoral PWV >10 m/s Ankle/brachial BP index

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