Abstract
The International Society of Hypertension (ISH) has recently developed practice guidelines
for the management of hypertension in adults aged ≥18 years. Conceptually, the 2020
ISH Guidelines are closer to the 2018 ESC/ESH Guidelines rather than to the 2017 ACC/AHA
Guidelines. The ISH Guidelines have two distinctive features when compared with the
2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) Guidelines
and the 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guidelines.
First, they are written in a concise and easy-to-read style; second, they focuses
on practical issues related to the management of hypertension in ‘high-income’ as
well as in ‘low-income’ countries, where there is limited access to resources for
the diagnosis and treatment of hypertension. In our opinion, the 2020 ISH Guidelines
share with the 2018 ESC/ESH Guidelines an important limitation which may impair the
retention of these key aspects of Guidelines by physicians, with consequent difficult
adoption in clinical practice. It consists in the definition of several blood pressure
targets in relation to age, target organ damage and concomitant disease. We believe
that results of randomized clinical trials and meta-analysis do not support the recommendation
of differential BP targets, as well as of rigid ‘safety boundaries’. This review critically
examines similarities and differences across the three major Hypertension Guidelines,
which include the definition of hypertension, drug treatment, and blood pressure targets,
with emphasis on key messages relevant for clinical practice.
Keywords
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Article info
Publication history
Published online: September 22, 2020
Accepted:
September 2,
2020
Received:
August 7,
2020
Identification
Copyright
© 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
