Covers drug treatment of arterial hypertension: when to start therapy and the ESC 2024 blood pressure targets, with lifestyle measures first. It then sets out first-line drug classes, a stepwise algorithm table, a table of main drug classes with doses, adverse effects and contraindications, and special groups such as diabetes, CKD, pregnancy and the elderly. It ends with resistant hypertension and hypertensive emergencies, including a table of emergency targets and intravenous drug doses.
Topic 35 of 139 in the MU Sofia syllabus for Internal Diseases and Therapy (Medicine, Years 4 and 5). The free AceMed note covers it in 6 sections, about 833 words (11 min of reading), with 13 flashcards.
In this note
Reminders
When to start drugs (ESC 2024)
Targets
Lifestyle (for every patient)
Drug treatment
Hypertensive emergencies
Reminders
Hypertension (ESC 2024): office blood pressure (BP) ≥ 140/90 mmHg, confirmed out of the office. Elevated BP: 120–139/70–89 mmHg.
The aim is to prevent stroke, myocardial infarction, heart failure and kidney failure; the benefit depends mainly on how far BP falls.
When to start drugs (ESC 2024)
Confirmed hypertension ≥ 140/90 mmHg: start drugs promptly together with lifestyle changes, whatever the cardiovascular risk.
Elevated BP (120–139/70–89): lifestyle for everyone; add drugs if the risk is high (cardiovascular disease, diabetes, moderate or severe chronic kidney disease, organ damage, familial hypercholesterolaemia, or SCORE2 10-year risk ≥ 10%) and BP stays ≥ 130/80 mmHg after 3 months.
Grade 3 BP (≥ 180/110) or organ damage: start at once. Age ≥ 85, frailty or symptomatic orthostatic hypotension: start from ≥ 140/90 and go slowly.
Targets
Systolic 120–129 mmHg for most adults, if tolerated — also in older patients, diabetes, chronic kidney disease (CKD), coronary disease and after stroke. Diastolic 70–79 mmHg. Reach the target within about 3 months.
If 120–129 is not tolerated, and in those ≥ 85 years, frail, with symptomatic orthostatic hypotension or limited life expectancy: "as low as reasonably achievable".
ESH 2023 is similar but less strict with age (systolic 130–139 from 65 and 140–150 from 80 years, lower if tolerated). The older targets of < 140/90 for everyone and < 150/90 above 80 years are outdated.
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