Hypertension ESC 2024

Question 1

Home-based blood pressure measurement : (>135/85)

Answer 1

1. Use a validated BP device
2. Measure BP in a quiet room after 5 min of rest with arm and back supported
3. Obtain two readings on each occasion, 1–2 min apart
4. Obtain readings twice a day (morninga and evening) for at least 3 and ideally 7 days
5. Record and average all readings and present results to clinician

Question 2

Office blood pressure measurement (140/90) :

Answer 2

1. Measure after 5 min seated comfortably in a quiet environment
2. Use a validated device with an appropriate cuff size based on arm circumference
3. Place the BP cuff at the level of the heart with the patient’s back and arm supported
4. Measure BP three times (1–2 min apart) and average the last 2 readings
5. Obtain further measurements if the readings differ by >10 mmHg
6. Measure BP in both arms at the Ist visit to detect between arm differences
7. Record heart rate and exclude arrhythmia by pulse palpation
8. Assess for orthostatic hypotension at Ist visit and thereafter by symptoms

Question 3

ABPM classification :

Answer 3

ABPM ≥130/80 mmHg over 24 h
or ≥135/85 mmHg for the daytime average
or ≥120/70 mmHg for the night-time average

Question 4

Hypertension

Answer 4

:
Office BP SBP ≥140 mmHg or DBP ≥90 mmHg
HBPM or ABPM SBP ≥135 mmHg or DBP ≥85 mmHg

Question 5

Elevated blood pressure

Answer 5

Office BP SBP 120–139 mmHg or DBP 70–89 mmHg
HBPM or ABPM SBP 120–134 mmHg or DBP 70–84 mmHg

Question 6

Assessing cardiovascular disease risk among individuals with elevated blood pressure :

Answer 6

1. moderate or severe CKD, established CVD, HMOD, diabetes mellitus, or familial hypercholesterolaemia : increased risk for CVD events.

Question 7

Risk modifiers

Answer 7

• sex-specific risk modifiers
Gestational diabetes
gestational hypertension
pre-term delivery
pre-eclampsia
one or more stillbirths
recurrent miscarriage
• Shared modifiers
High-risk ethnicity (e.g. South Asian),
family history of premature onset atherosclerotic CVD,
socio-economic deprivation,
auto-immune inflammatory disorders,
HIV,
severe mental illness

Question 8

Risk tools

Answer 8

CAC score
Carotid or femoral plaque
High-sensitivity cardiac troponin NT-proBNP
Pulse wave velocity

Question 9

Elevated BP management

Answer 9

1. Patient with elevated BP at office SBP 120–139 mmHg or DBP 70–89 mmHg
2. Established CVD, moderate/severe CKD, HMOD, DM, or FH (Class I) : go to 8
3. But if Patient with T2DM (only) and < 60 yo : calculate SCORE2-Diabetes
4. Calculate SCORE2 or SCORE2-OP (Class I) :
5. If > 10% then go to : 8
6. If >5% and <10% : consider risk modifiers : if any present : go to 8, otherwise consider risk tools and if + go to 8, else : nothing
7. If <5% : nothing
8. Lifestyle measures to reduce BP (Class I) / After 3 months of lifestyle measures, pharmacological treatment for patients with ≥130/80 mmHg (Class I)

Question 10

Screening for hypertension by office BP :

Answer 10

1. Hypertension ≥180/110 mmHg : Evaluate for hypertensive emergency (Class I)
2. Hypertension or elevated blood pressure w/ high risk : Confirm BP preferably with either home or ambulatory BP measurements (Class I)
3. Elevated blood pressure without high risk features or non elevated but age >40 yo : Opportunistic BP screening at least every year (Class IIa)
4. Non elevated blood pressure and age <40 yo : every 3 years

Question 11

Definition of resistant hypertension :

Answer 11

Hypertension is defined as resistant when a treatment strategy including appropriate lifestyle measures and treatment with maximum or maximally tolerated doses of a diuretic (thiazide or thiazide-like), a RAS blocker, and a calcium channel blocker fail to lower office systolic and diastolic BP values

Question 12

Causes of resistant hypertension

Answer 12

Behavioural factors
Overweight/obesity
Physical inactivity
Excess daily dietary sodium
Excess habitual alcohol consumption
Use of drugs or substances that may increase BP
Undetected secondary hypertension

Question 13

Initial monotherapy preferred

Answer 13

Elevated BP category (120/70–139/89 mmHg)
Moderate-to-severe frailty
Symptomatic orthostatic hypotension
Age ≥85 years

Question 14

When not to treat elevated blood pressure

Answer 14

Age ≥85 years,
moderate-to-severe frailty,
symptomatic OH,
short life expectancy
Elevated blood pressure without high risk features

Question 15

When to treat ?

Answer 15

When to treat ?
Confirmed hypertension
Or elevated blood pressure with high risk features (after 3 months of lifestyle measures)
Lifestyle measures Drug treatment for confirmed BP ≥130/80 mmHg Monitor BP and medication tolerance

Question 16

Target ?

Answer 16

Target ?
Target SBP 120–129 mmHg (Class I)
Target DBP 70–79 mmHg (Class IIb)