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Blood pressure, epidemiology and risk. Globally, over 1 billion people have hypertension. As populations age and adopt more sedentary lifestyles, the worldwide prevalence of hypertension will continue to rise towards 1.5 billion by 2025. Elevated blood pressure (BP) is the leading global contributor to premature death, accounting for almost 10 million deaths in 2015, 4.9 million due to ischaemic heart disease and 3.5 million due to stroke. Hypertension is also a major risk factor for heart failure, atrial fibrillation, chronic kidney disease (CKD), peripheral artery disease (PAD) and cognitive decline. 2. Definition of hypertension. The classification of BP and the definition of hypertension is unchanged from previous European guidelines, and is defined as an office SBP at least 140 mmHg and/or DBP at least 90 mmHg, which is equivalent to a 24-h ABPM average of at least 130/80 mmHg, or a home blood pressure monitoring (HBPM) average at least 135/ 85 mmHg. 3. Screening and diagnosis of hypertension. Hypertension is usually asymptomatic (hence the term 'silent killer'). Because of its high prevalence, screening programmes should be established to ensure that BP is measured in all adults, at least every 5 years and more frequently in people with a high-normal BP. When hypertension is suspected because of an elevated screening BP, the diagnosis of hypertension should be confirmed either by repeated office BP measurements, over a number of visits, or by out-of-office BP measurement using 24-h ABPM or by HBPM. 4. The importance of cardiovascular risk assessment and detection of HMOD. Other cardiovascular risk factors such as dyslipidaemia and metabolic syndrome frequently cluster with hypertension. Thus, unless the patient is already at high or very high risk due to established CVD, formal cardiovascular risk assessment is recommended using the SCORE system. It is important to recognize, however, that the presence of HMOD, especially left ventricular hypertrophy (LVH), chronic kidney disease (CKD) or advanced ... |