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Highlights from the 28th European Meeting on Hypertension and Cardiovascular Protection (ESH), Barcelona, Spain, June 8–11, 2018

Highlights from the 28th European Meeting on Hypertension and Cardiovascular Protection (ESH), Barcelona, Spain, June 8–11, 2018
  • Cardiometabolic
  • Hypertension

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Article

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International meeting
Hypertension
2018 hypertension guidelines
early vascular aging
immunology

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Practical

Professor Antonio Coca and the ESH Council organized a well-balanced meeting with a range of activities, including many state-of-the-art lectures, debates, breakfast workshops and round-table discussions on major issues of current interest and controversy. As in previous meetings, the programme covered the practical issues of the management of hypertension with teaching sessions, how-to seminars and meet-the-expert and clinical case sessions. Over 1000 abstracts were presented as either oral lectures or posters. A highlight of the meeting was the formal presentation of the 2018 ESC/ESH hypertension guidelines.


The meeting opened on a sad note with a memorial for Alberto Zanchetti (Milan, Italy) who passed away on March 24, 2018. Alberto Zanchetti’s achievements include an impressive range of scientific activities, a major role in the setting up and growth of both the International Society of Hypertension and the European Society of Hypertension as well the authorship and editorship of important books, journals, articles and guidelines in the hypertension field.

One of the most interesting novel scientific topics addressed during this meeting was assessment of early vascular ageing. Early intervention in the vascular ageing process has the potential of avoiding premature target organ damage and morbidity/mortality due to high blood pressure. Critical parameters, such as endothelial function, arterial stiffness and microvascular structure can now be assessed in a relatively simple and reproducible way. However, longitudinal studies are needed for more definitive conclusions on the effectiveness of early interventions in the vascular ageing process.

A second scientific development of great interest was the question, is hypertension an immunological disease? which was addressed during one of the teaching sessions and in the state-of-the-art lecture by Ernesto Schiffrin (McGill University, Montreal, Canada). Evidence to support this concept includes:

  • Polymorphisms in cytokine genes associated with hypertension
  • Haemodynamic forces affect immune cell vascular adhesion and promote neoantigen formation
  • Several environmental pollutants and nutrients are proinflammatory
  • Hypertension itself induces inflammation at specific sites, such as the kidney and in perivascular adipose tissue, thereby amplifying hypertension-related target organ damage. This amplification could underlie the long-term structural changes in the macro- and microvasculature in hypertensive disease.

The piece de résistance of the 2018 ESH meeting was the presentation of the 2018 ESC/ESH hypertension guidelines. These presentations were of special interest because of the international controversy after the recent publication of the US guidelines. The major difference between the US guidelines and the 2018 ESC/ESH guidelines is that the ESC/ESH guidelines still categorize patients with systolic/diastolic blood pressure of 130 to 139/85 to 89 mm Hg as having “high-normal” blood pressure. However, a new element in the European guidelines is the recommendation to target drug therapy to a systolic blood pressure <140 mm Hg for most patients but also to <130 mm Hg for patients younger than 65 years who can tolerate it. A diastolic blood pressure target of 80 mm Hg is recommended for everyone on drug therapy.

A major new recommendation in the 2018 European guidelines is to treat hypertension in most patients with two-drug therapy as initial therapy, preferably as a single pill combination. An important reason for the use of such single pill combinations is the potential for increased medication adherence.

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