ACC/AHA guidelines define hypertension as >130/80 mm Hg with a <130/80 mm Hg target for all, whereas ESC/ESH guidelines define it as >140/90 mm Hg with targets based on cardiovascular risk.
What are the differences between the ACC/AHA and ESC/ESH hypertension guidelines?
While both guidelines agree on lifestyle interventions and measurement techniques, they fundamentally differ on the blood pressure thresholds for defining and treating hypertension.
This study compares the recommendations of the most recent American College of Cardiology (ACC)/American Heart Association (AHA) and European Society of Cardiology (ESC)/European Society of Hypertension (ESH) blood pressure guidelines. Both guidelines represent updates of previous guidelines and reinforce previous concepts of prevention regarding elevated blood pressure. Specifically, a low-sodium diet, exercise, body weight reduction, low to moderate alcohol intake, and adequate potassium intake are emphasized. Overall, both guidelines agree on the proper method of blood pressure measurement, the use of home blood pressure and ambulatory monitoring, and restricted use of beta-blockers as first-line therapy. The major disagreements are with the level of blood pressure defining hypertension, flexibility in identifying blood pressure targets for treatment, and the use of initial combination therapy. Although initial single-pill combination therapy is strongly recommended in both guidelines, the ESC/ESH guideline recommends it as initial therapy in patients at ≥140/90 mm Hg. The ACC/AHA guideline recommends its use in patients >20/10 mm Hg above blood pressure goal. Thus, the only real disagreement is that the ACC/AHA guidelines maintain that all people with blood pressure >130/80 mm Hg have hypertension, and blood pressure should be lowered to 140/90 mm Hg, with the goal being a level <140/90 mm Hg for all targeting to <130/80 mm Hg only in those at high cardiovascular risk, but always considering individual tolerability of the proposed goal.
“The first thing people usually do with guidelines, and it's kind of a knee-jerk response, is to put them side by side and [ask] what can we find that's different and then make an awful lot out of that: 'The experts can't agree. It's a crisis situation. Patients have no confidence. Clinicians must be confused, etc.' ... because the vast majority of what we were recommending was very similar. Even in the area of greatest discord, which is classification of blood pressure, when it came to actual management, we were very similar.”
Bakris et al. (Sat,) conducted a review in Hypertension. ACC/AHA guidelines vs. ESC/ESH guidelines was evaluated. ACC/AHA guidelines define hypertension as >130/80 mm Hg with a <130/80 mm Hg target for all, whereas ESC/ESH guidelines define it as >140/90 mm Hg with targets based on cardiovascular risk.