The hypertension in the light of the new guidelines

Abstract

We present the optimal diagnostics and therapy of hypertension based on the latest Hungarian and European (ESH, ESC) hypertension guidelines. After the novelties and differences of the guidelines, we critically consider the relevant randomized, non-randomized, observational clinical trials, and describe what is not included or not included in this way in the guidelines based on the literature and practical experience, supplemented by the most common errors in domestic practice. We highlight the ones that are rarely used in diagnostics: the importance of the pulse, heart sounds, palpitations and panic disorder, the recognition of hypertension-induced silent ischemia, and echocardiographic abnormalities suggestive of hypertension. In blood pressure measurements, in addition to the importance of simultaneous blood pressure and ECG monitoring, we describe the sources of error in monitoring and the most effective telemedicine home measurements. In the treatment of hypertension, we follow a newly recommended strategy in the guidelines. When emphasizing individual risk assessment treatment, we highlight the risk markers of hypertension-mediated organ damage, the new, non-traditional risk factors. When individualizing antihypertensive treatment, we present the advantages and disadvantages of fixed combinations, the importance and application of chronopharmacotherapy, and the aspects of beta-blocker selection with the margin of errors.