New American and European Hypertension Guidelines, Reconciling the Differences

In November 2017, the American College of Cardiology and the American Heart Association released hypertension guidelines for the first time, replacing the Joint National Committee periodical reports, appearing from 1977 to 2003. In parallel, the European Society of Cardiology and the European Society of Hypertension updated their own recommendations with a new document released in August 2018. While both documents contain similar recommendations concerning several aspects of detection, prevention, and management of hypertension, they differ in some sensitive characteristics, which specifically affect diagnostic and therapeutic aspects. While the European guidelines do not substantially modify previous recommendations, the American proposals are clearly disruptive. Main examples include a new definition for hypertension, with a blood pressure threshold of 130/80 mmHg. Not only does it modify its prevalence, but also carries important changes in therapeutic aspects, including treatment initiation and blood pressure goals for treated patients. In this review, the main differences between American and European recommendations are highlighted, along with the arguments exposed by both groups of experts and their possible impact affecting clinical practice in hypertension management.