Hypertension guidelines in US and Europe: mind the gap

  • Bakris G & al.
  • J Am Coll Cardiol
  • 18 Jun 2019

  • International Clinical Digest
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Takeaway

  • This comparison of the latest European and US hypertension guidelines highlights their difference on a crucial issue: the cutoff for hypertension needing treatment:
    • US guidelines set a universal cutoff of >130/80 mmHg. 
    • European guidelines define it as >140/90 mmHg, targeting
  • Both use the same evidence base to reach these different conclusions, say the study authors, publishing in the Journal of the American College of Cardiology (JACC). 

Why this matters

  • Although recommendations agree on almost everything, the gap for defining treatment-requiring hypertension is substantial.

Key results

  • The 2 guidelines also diverge on when to use single-pill combination therapy: US recommendations call for use at >20/10 mmHg over goal vs European cutoff at ≥140/90 mmHg.
  • They do agree on other things, such as:
    • Emphasizing lifestyle modifications in all patients; 
    • Proper BP measurement (preparing patient with feet on floor and back supported, telling patient the values, using correct cuff size); and
    • Restricting use of beta-blockers to specific populations.

Study design

  • A guidelines comparison.
  • Funding: None disclosed.

Limitations

  • The authors are careful to say that “there is no fundamental problem with any of the guidelines.”