Here is a brief comparison of newly released ESC BP guidelines with the ACC 2017 guidelines:

The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines and the 2024 European Society of Cardiology (ESC) Guidelines for managing elevated blood pressure (BP) share similarities in their approach but also differ in several key aspects. Here’s a comparative summary:

Similarities:

1. Risk-Based Approach

Both guidelines emphasize a risk-based approach, where treatment intensity is determined by an individual’s cardiovascular risk, not just their blood pressure readings. This includes taking into account coexisting conditions like diabetes, chronic kidney disease, and heart disease.

2. Lifestyle Modifications

Both recommend lifestyle changes as the first line of treatment, including reductions in sodium intake, increasing physical activity, and managing weight. Lifestyle changes are critical regardless of the stage of hypertension.

3. Nonpharmacological Interventions

Nonpharmacological strategies such as reducing sodium, increasing potassium intake, and regular physical activity are strongly emphasized in both guidelines for patients with elevated BP and as a preventive strategy.

4. Ambulatory/Home BP Monitoring

Both guidelines recognize the importance of out-of-office BP monitoring (ambulatory and home BP measurements) for diagnosing and managing hypertension effectively. This approach helps to avoid “white coat hypertension” and identify masked hypertension.

Differences

1. BP Targets

The ACC/AHA guidelines recommend a lower treatment threshold of 130/80 mmHg for hypertension across most patient groups. This is stricter compared to the ESC guidelines, which still focus on initiating treatment at 140/90 mmHg for most individuals, though with recommendations to lower BP to less than 130/80 mmHg for high-risk individuals.

2. Risk Estimation Models

The ESC guidelines place a strong emphasis on cardiovascular risk prediction models, such as SCORE2, to tailor treatment. The ACC/AHA guidelines integrate risk calculation using tools like the ASCVD Risk Estimator but tend to prioritize BP thresholds more uniformly.

3. Pharmacological Treatment Initiation

The ESC guidelines lean more towards a stepwise approach, with consideration for starting single-pill combination therapy when appropriate. The ACC/AHA guidelines also recommend combination therapy for most patients but give more emphasis to initiating it earlier based on BP levels and cardiovascular risk.

4. Device-Based Therapies

The ESC guidelines are more explicit about the role of device-based therapies, such as renal denervation, which remains experimental and is not routinely recommended but discussed in detail as a future potential therapy. The ACC/AHA guidelines mention it briefly but do not delve as deeply into the emerging evidence.

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