The European Hypertension Society updated its clinical practice guideline for the management of patients with high blood pressure in July 2023 (HTA). The document, supported by the European Renal Association and the International Hypertension Societydoes not introduce major changes with respect to its previous version, despite which it gives rise to various useful reflections for its application in Internal Medicine: the definition of target organ damage and the need for a more practical approach.
Moderated by the internist José Abellán Alemánfrom the Internal Medicine service of the Murcia Hospital, two experts analyzed the keys to the new HTN guidelines in the first of the tables framed in the XX Vascular Risk Meeting of the Spanish Society of Internal Medicine (SEMI) which is celebrated from this Thursday in Malaga, namely, Enrique Rodilla Sala, from the Sagunto Hospital, in Valencia; and Eva Moya Mateofrom the Internal Medicine service of the Infanta Leonor University Hospital, in Madrid.
“The definition of the subclinical target organ injury “It continues to be very important in the new guidelines, a great beacon of how to guide treatment,” highlighted Rodilla, in charge of x-raying the changes introduced in the European HTA guideline.
The internist has highlighted the big but of the document updated in 2023: “The guides are excessively extensive“, he said, in this regard he recalled that, as a result of this, “shortly” a summary “of just ten figures” will be released that “intends to be a compendium of all the recommendations.”
Models to measure the risks of high blood pressure
For its part, Moya has analyzed the different criteria when evaluating the cardiovascular risks between, mainly, the European and North American models. According to the expert, despite the fact that in both cases there are “basic aspects” that are shared such as age, sex, tobacco consumption and whether or not one suffers from diabetes or some cardiovascular pathology, each model differs in points such as the cohort points to issue diagnoses.
“The fact of smoking or being diabetic is something that directly standardizes you as a high-risk patient, but, in the case of healthy people, its possible hypertension It depends on very varied circumstances, such as having a disease that inflames your joints or suffering from HIV”, he indicated.
It is in these aspects that the guides establish their own criteria – with the North American wing using the Framingham Study and the European one, the Score2 – something that, for Moya, responds to logic: “When evaluating vascular risk, it is best to use criteria adapted to the environment in which each person lives, which, on the other hand , will always have its own genetic characteristics and particularities.” The internist has recognized that each model has its pros and cons, but that, ultimately, the changes to evaluate risks present abysmal differences.
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