European and US guidelines for arterial hypertension: similarities and differences

Published:February 04, 2019DOI:


      • New Guidelines have been recently released from Europe and North America.
      • Main differences: categorization of hypertension, BP targets, and safety boundaries.
      • The US Guidelines lowered the threshold for hypertension to 130/80 mmHg.
      • The US Guidelines recommend a systolic BP target<130 mmHg in almost all patients.
      • Safety boundaries may induce to refrain from achieving ambitious BP targets.


      Hypertension is one of the most common chronic diseases in adults and a leading cause of disability and mortality worldwide. Recently, new Guidelines for the diagnosis and management of hypertension have been released in Europe and in the United States, with changes regarding how to diagnose and treat the condition, and the extent to which intensive blood pressure control should be pursued.
      Important differences between the Guidelines exist in the classification of blood pressure levels and definition of treatment goals. Diagnosis of hypertension starts at 140/90 mmHg for the European Guidelines, and 130/80 mmHg for the US Guidelines. Besides, the European guidelines introduced the concept of “safety boundaries”, consisting of BP thresholds not to be exceeded towards lower levels (120 mmHg for age < 65 years, 130 mmHg for older people) because of the fear of important adverse events associated with overtreatment. Such discrepancies can indeed have an impact on treatment attitudes and outcome incidence. Hence, we appraised facts in favor and against each of these controversial issues. In conclusion we believe that, instead of fixing rigid BP targets and boundaries, modern hypertension management should be aimed to achieve in each patient an optimal balance between intensive BP reduction and treatment safety.


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