Treatment

Initiating Treatment

These recommendations are presented in abbreviated form. Readers should refer to the guideline summary² and the complete guideline document¹ for a detailed discussion of each of the following topics.

Initiation of antihypertensive treatment (Table below) is based on two criteria:

Total level of cardiovascular risk
Level of systolic and diastolic BP

Goals of treatment

Achieve the maximum reduction in the total cardiovascular risk
Treat all reversible risk factors (smoking, dyslipidaemia, diabetes, etc.) and the associated clinical conditions
in addition to treating the raised BP
Reduce both systolic and diastolic BP to below 140/90 mmHg and to lower values if tolerated
Aim at values below 130/80 mmHg in diabetics
Achieving systolic BP values below 140 mmHg may be difficult in the elderly

	Blood pressure (mmHg)
Other risk factors and disease history	Normal: SBP 120–129 or DBP 80–84	High normal: SBP 130–139 or DBP 85–89	Grade 1: SBP 140–159 or DBP 90–99	Grade 2: SBP 160–179 or DBP 100–109	Grade 3: SBP > 180 or DBP > 110

No other risk factors	No BP intervention	No BP intervention	Lifestyle changes for several months, then drug treatment if preferred by the patient and resources available	Lifestyle changes for several months, then drug treatment	Immediate drug treatment and lifestyle changes
1-2 risk factors	Lifestyle changes	Lifestyle changes	Lifestyle changes for several months, then drug treatment	Lifestyle changes for several months, then drug treatment	Immediate drug treatment and lifestyle changes
3 or more risk factors or TOD or diabetes	Lifestyle changes	Drug treatment and lifestyle changes	Drug treatment and lifestyle changes	Drug treatment and lifestyle changes	Immediate drug treatment and lifestyle changes
ACC	Drug treatment and lifestyle changes	Immediate drug treatment and lifestyle changes	Immediate drug treatment and lifestyle changes	Immediate drug treatment and lifestyle changes	Immediate drug treatment and lifestyle changes

ACC, associated clinical conditions; DBP, diastolic blood pressure; SBP, systolic blood pressure; TOD, target organ damage.

References:
1. 2003 European Society of Hypertension–European Society of Cardiology guidelines for the management of arterial hypertension. Journal of Hypertension 2003, 21:1011–1053. Available at: http://www.eshonline.org/
2. Practice Guidelines for Primary Care Physicians: 2003 ESH/ESC Hypertension Guidelines. Available at: http://www.eshonline.org/

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Initiating Treatment