American, European and international hypertension guidelines: Time to shake hands?

BACKGROUND: Following evidence-based medicine through guidelines is the first step to successfully treat hypertension and prevent cardiovascular outcomes. METHODS: This study compares the recommendations of the most recent American College of Cardiology (ACC)/American Heart Association (AHA), European Society of Cardiology (ESC)/European Society of Hypertension (ESH) blood pressure and International Society of Hypertension (ISH) focusing on prevalent contrasts among guidelines on when, how and in whom start the treatment, which is a major health implications of guidelines. RESULTS: The three guidelines disagree for the cut-off values in the definition of hypertension. Due to the different cut-off values of BP at the definition of hypertension, a patient may be misclassified to one of the four phenotypes of BP from office and out of office measurements, based to which guidelines are followed by the physicians. In addition to this, each society propose different risk score to evaluate the cardiovascular risk in patients with hypertension. CONCLUSION: These differences cause a confusion not only to the general practitioners, but also the hypertension experts about the correct approach. The poor agreement between guidelines and diagnostic tools implies a huge number of patients remained unknown whether they should receive treatment.