2013 ESH/ESC Guidelines for the Management of Arterial Hypertension: What Has Changed in Daily Clinical Practice?
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REVIEW ARTICLE
2013 ESH/ESC Guidelines for the Management of Arterial Hypertension: What Has Changed in Daily Clinical Practice? Charalampos I. Liakos • Charalampos A. Grassos Dimitrios K. Babalis
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Received: 24 August 2014 / Accepted: 17 September 2014 Ó Springer International Publishing Switzerland 2014
Abstract This is a review article aiming to make focus on the changes made in the European Society of Hypertension (ESH)/European Society of Cardiology (ESC) guidelines for the management of arterial hypertension with some criticism for each element discussed in the text. Given that in the real world clinical practice physicians would hardly spend the time needed for studying the 77 pages manuscript of the recently released 2013 ESH/ESC hypertension guidelines, the present review summarizes all the significant updates (along with their clinical implications) compared to the 2007 ESH/ESC hypertension guidelines and the 2009 reappraisal document. Keywords Update
Hypertensive patients Position statement
Over the 4-year period after the reappraisal of the 2007 European Society of Hypertension (ESH)/European Society of Cardiology (ESC) guidelines for the management of arterial hypertension [1] made in 2009 [2], new evidence on several diagnostic and therapeutic aspects of
hypertension necessitated the edition of a new version of these guidelines. Publication of a new document, 6 years after the previous one, was felt to be timely. Thereby, the ESH/ESC Task Force released the new 2013 guidelines on hypertension [3] in the ESH annual Meeting. It is a lengthy document (77 pages), extremely comprehensive where all issues on the diagnostic evaluation, treatment approach and follow-up of hypertensive patients are thoroughly discussed. Thus, it is worthy to be studied by any physician dealing with hypertensive patients. However, in the real world clinical practice, for the majority of medical practitioners, it is at least doubtful if there is available time for the study of such a detailed manuscript. Given that the present guidelines [3] differ in many aspects from the previous ones [1, 2] and that the available pocket edition of the present guidelines is just a brief summary of the guidelines, a document making focus on the most important changes made in daily clinical practice would be of wide utility saving valuable time for physicians. The present review summarizes the updates made on the ESH/ESC hypertension guidelines with some critical comments or/and suggestions to improve implementation of these guidelines. The most significant novelties are listed below:
1 Classes of Recommendations—Levels of Evidence
C. I. Liakos C. A. Grassos D. K. Babalis Hypertension Outpatient Unit, Cardiology Department, ‘‘KAT’’ General Hospital of Attica, 14561 Athens, Greece C. I. Liakos (&) 31 Stavraetou Street, 15772 Athens, Greece e-mail: [email protected]
While not done in previous editions, the 2013 guidelines [3] grade the strength of recommendations (I, IIa, IIb or C) and the level of scientific evidence (A, B or C
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