Diagnosis and management of hypertension in primary care

Raised blood pressure (BP) or hypertension is a major preventable cause of cardiovascular disease (CVD) and all-cause death. Among adults, the overall prevalence is around 30-45%, but hypertension becomes progressively more common with increasing age, up to a prevalence of more than 60% in people of 60 years and older. Moreover, it is well established that lowering BP can substantially reduce premature morbidity and mortality. However, BP control rates are often inadequate. Only about 40% of patients with hypertension are treated, and of these only about 35% achieve BP to a target of less than 140/90 mmHg. This document aims to guide general practitioners (GPs) and other primary care physicians on how to manage vascular disease in hypertensive patients in primary care, including how to deal with challenges faced in clinical practice. The document considers discrepancies between international guidelines in definitions of hypertension and recommendations on when to start treatment. The European Primary Care Cardiovascular Society (EPCCS) supports the hypertension categories defined in the 2018 European Society of Hypertension (ESH)/European Society of Cardiology (ESC) guidelines. Recent evidence that has influenced the guidelines is briefly discussed. Current recommendations on how to monitor BP and diagnose hypertension, and management options, both lifestyle modifications and pharmacotherapeutic options are provided.