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European guidelines on hypertension more flexible than those in United States

BMJ 2004; 328 doi: (Published 27 May 2004) Cite this as: BMJ 2004;328:1279
  1. Janice Hopkins Tanne
  1. New York

    European experts in hypertension take a flexible approach to defining and treating high blood pressure, but the European and US guidelines are not really that far apart, said Dr Giuseppe Mancia, chairman of the department of medicine at the University of Milan-Bicocca. “The European goal is reduction of long term cardiovascular risk,” he said at the American Society of Hypertension meeting in New York last weekend.

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    US guidelines suggest that the risk of cardiovascular disease begins at 115/75 mm Hg


    Last year the US guidelines said that the risk of cardiovascular disease began at 115/75 mm Hg and called systolic pressures of 120 to 130 mm Hg and diastolic pressures of 80 to 89 mm Hg “prehypertension.” Thiazide-type diuretics were recommended for most patients, but two or more drugs would usually be needed to control hypertension (BMJ 2003;326: 1104g).

    The European guidelines say optimal blood pressure is below 120/80 mm Hg; normal blood pressure is 120-129 mm Hg systolic and 80-84 mm Hg diastolic; and “high normal” is 130-139 mm Hg systolic and 85-89 mm Hg diastolic. The guidelines categorise patients' cardiovascular risk depending on the presence of factors such as older age, smoking, dyslipidaemia, and family history of early cardiovascular disease, as well as considering signs of damage to the left ventricle, kidneys, or arterial wall and whether the patient has diabetes.

    Dr Mancia said the difference between the US and European guidelines was that in calling some pressures “prehypertension,” the American guidelines tended to result in patients becoming anxious and led to intrusive lifestyle changes, medical visits, and laboratory tests. Dr Mancia suggested that the concept of prehypertension represented a certain way of looking at things, similar to the idea that the whole of life was a “pre-death experience.”

    Dr David Lackland, professor of medicine at the University of South Carolina in Charleston, described the programme of the society's regional chapter for implementing the US guidelines in the “stroke belt” of North and South Carolina and Georgia, where rates of stroke, heart attack, and end stage renal disease are high.

    Dr Daniel Levy of Framingham, Massachusetts, said there were barriers to implementing goals. Although 69% of hypertensive patients in the United States are aware of their disorder—compared with only 36% in the United Kingdom—control was still poor.

    “The problem is systolic blood pressure in older patients who have older physicians,” he said.

    The US guidelines are at The European guidelines, are

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