Recommendations on arterial hypertension 2007: Text, context, and speculations

At the Congress of the European Society on Arterial Hypertension (AH) in June 2007 in Milan were presented Second European Recommendations on AH traditionally attracting huge attention. Novel Recommendations appear to be revision of the 2003 variant and in distinction to recommendations of WHO are oriented to more high economical potential of European Countries. Positions contained in the novel version in recommendations reflect contemporary knowledge about AH in connection with this their educational but not directive or prescribing character is distinctly designated. It is underlined that data of different degree of proof are used. The lack of objective criteria of proof creates problems of comparison with other recommendations. Diagnostic level of AH >= 140/90 mm Hg remained previous however these figures not always appear to be target values. Besides patients with diabetes mellitus diabetes, renal insufficiency and proteinuria to categories of patients to whom achievement of lower target values is required patients with very high risk first of all those who have survived myocardial infarction and stroke are referred. This change will lead to more low parameters of controllable AH. In distinction from 2003 recommendations of American experts in the given recommendations the term "prehypertension" is not used. Big significance is devoted to parameters of BP during ambulatory or home measurement and their norms are given. it is underlined that all parameters of BP are very important for prognosis but long term prognosis more closely tied with ambulatory BP than with single measurements by physician. Novel notions are defined "masked (concealed) AH" and "central BP". Received further development concept of assessment of total cardiovascular risk, according to which BP is a component of multiprofile spectrum of risk factors. Compliance with this concept creates problems of assessment of specific significance of elevated BP as risk factor. It should be underlined that there exists an alternative concept according to which elevated BP occupies first and most significant position in hierarchy of risk factors. For assessment of total risk acknowledgement as referent studies of not only Framingham but also European studies appears important. Necessity of further development of the system of risk assessment SCORE is underlined, since it is tied only with mortality. in items devoted to assessment of risk factors and involvement of target organs there substantial changes occurred. Great attention is given to evaluation of elasticity of arteries and ankle-brachial index for detection of diseases of peripheral arteries. However one should note limited availability of these indexes especially of the rate of pulse wave propagation. In relation to choice of antihypertensive preparations no substantial changes took place compared with 2003 variant. In is underlined that in treatment of AH achievement of target BP is important but not the mode of its achievement. Augmented position of combined therapy in that number at the start of treatment leads further away from discussion with what class of antihypertensive preparations one should begin treatment. Recommendations on prescription of beta-adrenoblockers have not changed. Necessity of change of way of life as first and most effective method of control of BP clearly designated. Indications to prescription of statins are widened and concretized.