Reconciling Systolic Blood Pressure Intervention Trial With Eighth Joint National Commission

A Nuanced View of Optimal Hypertension Control in the Chronic Kidney Disease Population

Ekamol Tantisattamo; Anum Hamiduzzaman; Peter Sohn; Rebecca Ahdoot; Ramy M. Hanna


Curr Opin Nephrol Hypertens. 2022;31(1):57-62. 

In This Article

European Society of Hypertension/European Society of Cardiology (ESH/ECC)

The 2018 European Society of Hypertension/European Society of Cardiology (ESH/ECC) guidelines define a prehypertension or low-risk hypertension group if BP is 130–139/85–89 mmHg.[27] In this group, lifestyle modification is recommended unless there is a high incidence of CVD (mirroring AHA/ACC guidelines), there is no strong push for pharmacotherapy in this cohort.[27]

The ESH/EC also defines a lower risk versus higher-risk stage I hypertension group >140mmHg where CV risk may be used to stratify the immediacy of pharmacotherapy.[27] A higher risk BP group exists, analogous to JNC-8 stage II hypertension where pharmacotherapy is strongly recommended.[27] Guidelines for use of mineralocorticoid receptor agonists and alpha1 agonists are also suggested for resistant hypertension. The guidelines also define a higher acceptable hypertension threshold for patients > 65 years of age but <80 years of age and that goal is 140–159 mmHg, similar to the JNC-8 recommendations.[27] The guidelines are nuanced and manage to weave together elements of JNC-8 and SPRINT data.