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Collection Highlights

Manual of Hypertension of the European Society of

Hypertension Second Edition Giuseppe Mancia

Essentials of Hypertension: The 120/80 paradigm 1st

Edition Flávio Danni Fuchs (Auth.)

Resistant Hypertension in Chronic Kidney Disease 1st

Edition Adrian Covic

Hypertension and Heart Failure - Epidemiology, Mechanisms

and Treatment (Updates in Hypertension and Cardiovascular
Protection), 2e (Apr 2, 2024)_(3031393147)_(Springer) 2nd
Edition Maria Dorobantu
Clinical Cases in Chronic Thromboembolic Pulmonary
Hypertension William R. Auger

Pulmonary Hypertension: Basic Science to Clinical Medicine

1st Edition Bradley A. Maron

Hypertension: A Companion to Braunwald's Heart Disease 3rd

Edition George L. Bakris

Hypertension from basic research to clinical practice

Volume 2 1st Edition Md. Shahidul Islam

Hypertension and Organ Damage A Case Based Guide to

Management 1st Edition Giuliano Tocci (Auth.)
THIRD EDITION

Manual of
Hypertension
of the European Society of Hypertension
THIRD EDITION

Manual of
Hypertension
of the European Society of Hypertension
EDITED BY

Giuseppe Mancia, Professor

University of Milano-Bicocca, Milan and Policlinico di Monza, Monza, Italy

Guido Grassi, Professor

Clinica Medica, Department of Medicine and Surgery,
University of Milano-Bicocca, Milan, Italy

Konstantinos P. Tsioufis, Professor

National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece

Anna F. Dominiczak, Professor

Institute of Cardiovascular and Medical Sciences, University of Glasgow,
Glasgow, Scotland, United Kingdom

Enrico Agabiti Rosei, Professor

Department of Clinical and Experimental Sciences,
University of Brescia, Brescia, Italy
CRC Press
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 Contents

Editors xi
Contributors xiii
Introduction xxiii

section I Background and Epidemiology

1. History of the European Society of Hypertension: Past,
Present and Future 3
Konstantinos P. Tsioufis and Enrico Agabiti Rosei

2. Hypertension as a Cardiovascular Risk Factor 7

Renata Cifkova and Peter J. Blankestijn

3. Hypertension and the Kidney 19

Roberto Pontremoli, Giovanna Leoncini and Francesca Viazzi

4. Blood Pressure Control in Europe and Elsewhere 25

Josep Redon, Gernot Pichler and Fernando Martinez

5. Socioeconomic Determinants 31
Theodora Psaltopoulou and Theodoros N. Sergentanis

section II Etiological and Pathophysiological

Aspects
6. Hemodynamic Patterns in Hypertension 37
Per Omvik and Per Lund-Johansen

7. Genetic Basis of Blood Pressure and Hypertension 51

Sandosh Padmanabhan, Alisha Aman and Anna F. Dominiczak

8. Oxidative Stress, Inflammation, Immune System and Hypertension 67

Damiano Rizzoni, Livia L. Camargo, Francisco J. Rios, Augusto C. Montezano
and Rhian M. Touyz
 vi Contents

9. Sodium and Potassium 75

Lanfranco D’Elia and Pasquale Strazzullo

10. Structural Cardiovascular Changes in Hypertension 81

M. Mulvany, Enrico Agabiti Rosei and H. Struijker-Boudier

11. Early Vascular Ageing 89

Peter M. Nilsson and Stéphane Laurent

12. Autonomic Dysfunction 95

Gino Seravalle and Guido Grassi

13. The Renin−Angiotensin−Aldosterone System 101

Ulrike M. Steckelings and Thomas Unger

14. Stress, Stress Reduction and Hypertension: An Updated Review 109

Komal Marwaha and Robert H. Schneider

section III Associated Risk Factors: Pathogenetic

Role and Risk Modification
15. Heart Rate as a Cardiovascular Risk Factor in Hypertension 121
Paolo Palatini

16. Obesity and Obstructive Sleep Apnoea 127

Dagmara Hering, Jacek Wolf, Marzena Chrostowska and Krzysztof Narkiewicz

17. The Metabolic Syndrome in Hypertension 135

Josep Redon, Fernando Martinez and Gernot Pichler

18. Psychosocial Risk Factors, Airborne Pollution, Hypertension and

Cardiovascular Diseases 149
Philippe van de Borne

19. Serum Uric Acid, Blood Pressure and Hypertension 155

Claudio Borghi

20. Dyslipidaemia in Hypertension 163

Massimo Volpe, Giovanna Gallo and Giuliano Tocci

section IV Blood Pressure Measurements

21. Old and New Office Blood Pressure Measurement Approaches 171
Michael Bursztyn and Iddo Z. Ben-Dov

22. Pulse Pressure 177

Pierre Boutouyrie and James E. Sharman
 Contents vii

23. Central Blood Pressure 183

Stéphane Laurent and Cristina Giannattasio

24. Ambulatory Blood Pressure Measurement 191

Eoin O’Brien, Eamon Dolan and Jan Staessen

25. Home Blood Pressure 197

George S. Stergiou and Anastasios Kollias

26. Day-Night Related Events: Nighttime Blood Pressure Fall and

Morning Blood Pressure Rise 203
Fabio Angeli, Gianpaolo Reboldi, Monica Trapasso and Paolo Verdecchia

27. Short-Term Blood Pressure Variability 209

Gianfranco Parati, Thomas F. Luscher and Juan Eugenio Ochoa

28. Exercise Blood Pressure: The Prognostic Impact

of Exercise Systolic Blood Pressure 217
Julian E. Mariampillai, Per Torger Skretteberg, Sverre E. Kjeldsen,
Johan Bodegård and Jan E. Erikssen

section V Organ Damage-Measurement/

Clinical Value
29. Cardiac Damage from Left Ventricular Hypertrophy to Heart Failure 225
Enrico Agabiti Rosei, Maria Lorenza Muiesan and Cesare Cuspidi

30. Structural and Functional Aspects of Brain Damage 241

Cristina Sierra, Miguel Camafort and Antonio Coca

31. Large Artery Damage: Measurement and Clinical Importance 247

Stéphane Laurent and Michel E. Safar

32. Microcirculation 253

Reza Aghamohammadzadeh and Anthony M. Heagerty

33. Endothelial Damage 261

Stefano Masi, Rosa Maria Bruno, Lorenzo Ghiadoni, Agostino Virdis
and Stefano Taddei

34. Retinal Changes 275

A. Bosch and Roland E. Schmieder

section VI Integrated Diagnostic Aspects

35. The Integrated Diagnostic Approach in General Medicine 283
Andrzej Więcek, Aleksander Prejbisz and Andrzej Januszewicz
 viii Contents

36. Management of Hypertension by the Hypertension Specialist and the

Hypertension Excellence Centres 293
Bojan Jelaković

section VII Therapeutic Aspects

37. Non-Pharmacological Interventions 303
Stefan Engeli and Jens Jordan

38. The Protective Cardiovascular Effects of Antihypertensive Treatment 311

Alberto Zanchetti (Late) and Costas Thomopoulos

39. The Nephroprotective Effect of Antihypertensive Treatment 319

Luis M. Ruilope and Jose R. Banegas

40. Antihypertensive Drug Classes 325

Engi Abdel-Hady Algharably and Reinhold Kreutz

41. Single-Pill Combination Treatments in Hypertension 337

Michel Burnier

42. The J-Curve Phenomenon 345

Louis Hofstetter and Franz H. Messerli

43. A Polypill for Global Cardiovascular Prevention: Current Data and

Future Perspectives 353
José Maria Castellano, Mónica Doménech and Antonio Coca

44. Managing Adverse Effects and Drug Intolerance 363

Nikitas Alexander P. Skliros, Antonios A. Argyris and Athanase D. Protogerou

45. Adherence to Treatment in Hypertension 369

Michel Burnier

46. Residual Risk in Treated Patients 379

Giuseppe Mancia

section VIII Special Conditions

47. Ethnic Factors in Hypertension 389
Katarzyna Stolarz-Skrzypek, Danuta Czarnecka and
Andrzej Januszewicz

48. Resistant Hypertension: Medical Treatment 395

Michel Azizi, Laurence Amar, Aurélien Lorthioir
and Anne-Marie Madjalian
 Contents ix

49. Interventional Therapies for Essential Hypertension 401

Konstantinos P. Tsioufis, Kyriakos Dimitriadis, Alex Kasiakogias
and Vassilios Papademetriou

50. Atrial Fibrillation and Arterial Hypertension 411

D.E. Athanasiou, M.S. Kallistratos, L.E. Poulimenos and A.J. Manolis

51. The Diabetic/Obese Hypertensive Patient

(Including Metabolic Syndrome) 417
Vasilios Kotsis

52. Hypertension in Children and Adolescents 425

Empar Lurbe and Pau Redon

53. Hypertensive Emergencies and Urgencies 431

Maria Lorenza Muiesan, Anna Paini, Claudia Agabiti Rosei, Fabio Bertacchini
and Massimo Salvetti

54. Hypertension Associated with Peripheral Artery Disease 439

Denis L. Clement

55. Hypertension in Pregnancy 445

Renata Cífková

56. Drug-Induced Hypertension 455

Gurvinder Rull and Melvin D. Lobo

57. Hypertension in Patients with Advanced Chronic Kidney Disease 463

Charalampos Loutradis and Pantelis Sarafidis

58. Blood Pressure Management in Acute Stroke 479

Efstathios Manios, Eleni Koroboki and Konstantinos Vemmos

59. Blood Pressure Management in the Chronic Post-Stroke Phase 487

Hisatomi Arima and John Chalmers

60. The Post-Transplant Patient with Hypertension 493

Martin Hausberg and Karl Heinz Rahn

section IX Secondary Hypertension: Diagnosis

and Treatment
61. Renovascular Hypertension 503
Peter W. de Leeuw and Alberto Morganti

62. Primary Aldosteronism 511

Gian Paolo Rossi

63. Pheochromocytoma and Paraganglioma 523

Andrzej Januszewicz, Jacques W.M. Lenders, Graeme Eisenhofer
and Aleksander Prejbisz
 x Contents

section X Additional Aspects

64. Follow-Up of the Hypertensive Patient 535
Michael Doumas, Konstantinos Stavropoulos, Gemma Currie and Christian Delles

65. 2018 ESC/ESH Hypertension Guidelines 543

Bryan Williams, Giuseppe Mancia, Wilko Spiering, Enrico Agabiti Rosei,
Michel Azizi, Michel Burnier, Denis L. Clement, Antonio Coca, Giovanni de Simone,
Anna F. Dominiczak, Thomas Kahan, Felix Mahfoud, Josep Redon, Luis M. Ruilope,
Alberto Zanchetti (Late), Mary Kerins, Sverre E. Kjeldsen, Reinhold Kreutz, Stephane Laurent,
Gregory Y.H. Lip, Richard McManus, Krzysztof Narkiewicz, Frank Ruschitzka,
Roland E. Schmieder, Evgeny Shlyakhto, Konstantinos P. Tsioufis, Victor Aboyans and
Ileana Desormais

Index 629
 Editors

Professor Giuseppe Professor Guido Grassi, MD, is

Mancia, MD, PhD, a Full Professor of Internal
is Profes­ sor Emeri- Medicine at the Clinica Medica
tus, University of of the University of Milano-
Milano-Bicocca; Bicocca, and the Director of
President, European the Clinica Medica Institute at
Society of Hyperten- Saint Gerardo Hospital-Monza/
sion (ESH) Founda- Milano (Italy). He is the Director
tion; Chairman, ESH of the Post-Graduate School of
Educational Board; Internal Medicine and of the
Past President, Inter- PhD course in Public Health,
national Society of University of Milano-Bicocca.
Hypertension, European Society of Hypertension, Euro- He was the Vice-Chairman (2002–2004) and the
pean Society of Clinical Investigation and Italian Society of Chairman (2004–2006) of the Working Group
Hypertension. He is the Chairman of the Board of the Ital- Hypertension and the Heart of ESC. He was a Treasurer
ian scientific societies involved in cardiovascular preven- and then Secretary of the Italian Society of Hypertension
tion and has been the Head of the Department of Medicine (2004–2007). He was a member of the Task Force of the
of the S. Gerardo Hospital, Monza, University of Milan and ESH/ESC for the 2007 guidelines on hypertension in
Milano-Bicocca. Dr. Mancia has been invited to give the 2006–2007. He was the Wright Lecturer at the Annual
state-of-the-art or keynote plenary lectures in more than Meeting of the High Blood Pressure Council of Australia
700 international meetings. He has received several presti- in 2007. He was a member of the Scientific Council of the
gious awards and degrees Honoris Causa for his work on ISH for the periods 2008–2012 and 2012–2016. Dr. Grassi
hypertension and is an honorary member of many hyper- received the Björn Folkow Award from ESH in 2009. His
tension or cardiac scientific societies. He has also received research interests include pathophysiology, clinical phar-
the title of Commander of the Order of the Italian Republic macology; and treatment of hypertension, obesity and
for excellence in scientific activity. He has published more metabolic syndrome, cardiac arrhythmias and heart fail-
than 2000 original papers in peer-reviewed scientific jour- ure. He has published more than 600 original papers and
nals. His papers have received more than 190,000 citations reviews in major scientific international journals
with an h-index of 166. He has been on the list of highly (h-index 87). Dr. Grassi is the Executive Editor of the
cited investigators for several years. He is the editor-in-chief Journal of Hypertension, Section Editor of the Journal of the
of the Journal of Hypertension, the official journal of the American Society of Hypertension, Co-Editor of Current
International and European Hypertension Societies. Hypertension Reviews and a member of the editorial board
of major international journals. He received the Talal Zein
Award from ESH in 2017. He was the Vice President of the
Italian Society of Hypertension during 2017–2019, and the
President during 2019–2021. He was appointed as ESC/
ESH Expert Reviewer of the 2018 ESC/ESH guidelines on
hypertension. In 2018, Dr. Grassi received the Paul Korner
Award from ISH.
 xii Editors

Professor Konstantinos P. European Society of Cardiology and the Society of Biology.

Tsioufis, MD, PhD, FESC, FACC, She is a member of the British Medical Association,
is a Professor of Cardiology and British Hypertension Society, European Society of
the Director of the Hypertension Hypertension, International Society of Hypertension,
Unit of the Hippokration Hospi­ British Endocrine Society, Association of Physicians of
tal, National and Kapodistrian Great Britain and Ireland, American Physiological Society,
University of Athens, Greece. British Atherosclerosis Society, British Cardiovascular
Professor Tsioufis works as an Society and European Atherosclerosis Society. From 2013
Interventional Cardiologist as to 2015, she was President of the European Society of
well as Hyper­tension Special­ist Hypertension.
in the 1st Department of Since 2012, she has been editor-in-chief of Hypertension,
Cardiology, University of Athens, journal of the American Heart Association and the world’s
and he was a post-doctoral fellow at the Veterans Affairs top journal in her area of research.
Medical Centre, Georgetown University Washington DC.
Professor Tsioufis’s research focuses on hypertensive Professor Enrico Agabiti Rosei
disease, atherosclerotic cardiovascular disease and inter­ MD, PhD, FESC, is a Professor
ventional cardiology, including novel interventional ther­ Emeritus at University of Brescia.
apies of hypertension. He is interested in heart failure, He was the Director of the Clinica
metabolic disorders and diabetes mellitus and clinical tri­ Medica for many years for the
als. He has more than 390 publications in peer-reviewed Post-Graduate School of Internal
journals, h-index 50, more than 10,500 citations and Medicine at the University of
more than 400 invited lectures at international meet­ Brescia. He was the Chairman
ings. He is a member of the Task Force for writing the of the Clinical Department of
2018 joint ESC/ESH guidelines for hypertension. He is a Medicine, Azienda Spedali Civili,
co-editor of the book Interventional Therapies for Secondary University Hospital, Brescia, and
and Essential Hypertension, and has contributed more than the Department of Clinical and
20 chapters in books. He is a member of the editorial Experimental Sciences, University of Brescia, until end of
board and reviewer in many cardiology and hyperten­ 2017.
sion journals. Professor Tsioufis is the President of the Professor Agabiti Rosei graduated in medicine and surgery
European Society of Hypertension (ESH) (2017–2019) and at the University of Perugia and specialized in cardiology
was the President of the Hellenic Society of Cardiology and internal medicine at the University of Pisa; then spent
(2016–2018). a few years in prestigious international research centers as
a visiting research fellow or visiting professor: in Glasgow,
Professor Dame Anna F. GB, at BP Unit; in Basel, Switzerland, at Kantonsspital; and
Dominiczak, DBE, MD, FRCP, in Cleveland, Ohio, at the Cleveland Clinic.
FAHA, FRSE, FMedSci, is Regius He has lectured internationally on topics related to
Professor of Medicine, Vice hypertension and cardiovascular diseases, and has also
Principal and Head of the College been responsible for organizing official workshops and
of Medical, Veterinary and Life symposia of the European Society of Hypertension, and of
Sciences at the University of the European Society of Cardiology.
Glasgow, as well as honorary The author of approximately 800 scientific publications
consultant physician and non-­
­ in peer-reviewed journals (h-index 72), Professor Agabiti
executive member of the NHS Rosei is also a co-editor and/or author of chapters of many
Greater Glasgow and Clyde books on several aspects of hypertension and cardiovas­
Health Board. In 2016, she was cular prevention.
awarded a DBE for services to car­ He is a scientific referee or editorial board member of
diovascular and medical science. several major scientific journals, as well as an honorary
Professor Dominiczak is one of the world’s leading car­ member of several hypertension scientific societies. He
diovascular scientists and clinical academics. She held a received the Peter Sleight Award of the ESH in 2011, and
British Heart Foundation Chair of Cardiovascular Medicine the title of Commander of the Order of the Italian Republic
at the University of Glasgow from 1997 to 2010, and direc­ for excellence in scientific activity.
torship of the Cardiovascular Research Centre from 2000 Professor Agabiti Rosei is the President of the Camillo
to 2010. Her major research interests are in hypertension, Golgi Foundation for Biomedical Research. He was a
cardiovascular genomics and precision medicine, where she member of the Task Force for writing the 2018 ESC/ESH
not only publishes extensively in top peer-reviewed jour­ guidelines for hypertension, and was also a Task Force
nals (over 400 publications), but also excels in large-scale member or scientific reviewer of all the previous ESH/ESC
research funding for programmes and infrastructure (with guidelines (from 2003).
a total value in excess of £100M over the last seven years). He was the President of the European Society of
She leads a collaboration of four universities, four academic Hypertension (2015–2017) of the Italian Society of
NHS Health Boards across Scotland and two major industry Hypertension, the Chairman of the Working Group
partners in a public/private partnership focused on preci­ on Hypertension and the Heart of the European Society
sion medicine, with a value in excess of £20M. of Cardiology, as well as a member of the Science Council
Professor Dominiczak is a Fellow of the Royal College of of the European Society of Cardiology and of the Execu­
Physicians, the American Heart Association, the Academy tive Committee of the European Council for Cardiovas­
of Medical Sciences, the Royal Society of Edinburgh, the cular Research.
 Contributors

Victor Aboyans Antonios A. Argyris

Department of Cardiology Cardiovascular Prevention and Research Unit
Centre Hospitalier Universitaire de Limoges Clinic and Laboratory of Pathophysiology
Limoges, France Department of Medicine
National and Kapodistrian University of Athens
Enrico Agabiti Rosei Athens, Greece
Department of Clinical and Experimental Sciences
University of Brescia Hisatomi Arima
Brescia, Italy Department of Preventive Medicine and Public Health
Fukuoka University
Reza Aghamohammadzadeh Fukuoka, Japan
Division of Cardiovascular Sciences and
The University of Manchester The George Institute for Global Health
Manchester, United Kingdom University of New South Wales
Sydney, Australia
Engi Abdel-Hady Algharably D.E. Athanasiou
Institut für Klinische Pharmakologie und
Cardiology Department
Toxikologie
Asklepieion General Hospital
Charité – Universitätsmedizin Berlin
Voula, Hellas, Greece
Berlin, Germany
Michel Azizi
Alisha Aman Hypertension Unit
Institute of Cardiovascular and Medical Sciences Hôpital Européen Georges Pompidou and Paris – Descartes
Glasgow, Scotland, United Kingdom University
Paris, France
Laurence Amar
Hypertension Unit Jose R. Banegas
Hôpital Européen Georges Pompidou and Paris – Descartes Department of Preventive Medicine and Public Health
University School of Medicine
Paris, France Universidad Autónoma de Madrid/IdiPAZ and CIBERESP
Madrid, Spain
Fabio Angeli
Department of Cardiology and Cardiovascular Iddo Z. Ben-Dov
Pathophysiology Nephrology and Hypertension Service
Hospital S.M. della Misericordia Hadassah – Hebrew University Medical Centers
Perugia, Italy Jerusalem, Israel
 xiv Contributors

Fabio Bertacchini Livia L. Camargo

Department of Clinical and Experimental Sciences Institute of Cardiovascular and Medical Sciences
University of Brescia BHF Glasgow Cardiovascular Research Centre
Brescia, Italy University of Glasgow
Glasgow, Scotland, United Kingdom
Peter J. Blankestijn
Department of Nephrology and Hypertension José Maria Castellano
Utrecht Medical Center Centro Nacional de Investigaciones Cardiovasculares
Utrecht, The Netherlands Instituto de Salud Carlos III
and
Johan Bodegård Centro Integral de Enfermedades Cardiovasculares
Department of Cardiology Hospital Universitario Montepríncipe
Oslo University Hospital HM Hospitales
Ullevaal, Oslo, Norway and
Facultad de Medicina
Claudio Borghi Universidad CEU San Pablo
Department of Medicine Madrid, Spain
Hypertension Unit
University of Bologna John Chalmers
Bologna, Italy The George Institute for Global Health
University of New South Wales
Philippe van de Borne Sydney, Australia
Department of Cardiology
Hypertension Unit Marzena Chrostowska
Université Libre de Bruxelles Department of Hypertension and Diabetology
Brussels, Belgium Medical University of Gdansk
Gdansk, Poland
A. Bosch
Department of Nephrology and Hypertension
Renata Cífková
Friedrich Alexander University
Center for Cardiovascular Prevention
Erlangen-Nuremberg (FAU)
Charles University in Prague
Erlangen, Germany
First Faculty of Medicine and Thomayer Hospital
and
Pierre Boutouyrie Department of Medicine II – Cardiology and Angiology
Université Paris – Descartes Charles University in Prague
Assistance – Publique Hôpitaux de Paris First Faculty of Medicine and General University Hospital
INSERM Prague, Czech Republic
Paris, France
Denis L. Clement
Rosa Maria Bruno University Hospital
Department of Clinical and Experimental Medicine
Department of the Dean
University of Pisa
Gent, Belgium
Pisa, Italy

Michel Burnier Antonio Coca

Service of Nephrology and Hypertension Hypertension and Vascular Risk Unit
Department of Medicine Department of Internal Medicine
Centre Hospitalier Universitaire Vaudois Hospital Clinic, IDIBAPS
Lausanne, Switzerland University of Barcelona
Barcelona, Spain
Michael Bursztyn
Department of Medicine Gemma Currie
Mount Scopus and Ein-Kerem Institute of Cardiovascular and Medical Sciences
Jerusalem, Israel BHF Glasgow Cardiovascular Research Centre
University of Glasgow
Miguel Camafort Glasgow, Scotland, United Kingdom
Hypertension and Vascular Risk Unit
Department of Internal Medicine Cesare Cuspidi
Hospital Clinic, IDIBAPS Department of Medical and Surgical Sciences
University of Barcelona University of Milan-Bicocca
Barcelona, Spain Milan, Italy
 Contributors xv

Danuta Czarnecka Jan E. Erikssen

1st Department of Cardiology Faculty of Medicine
Interventional Electrocardiology and Hypertension University of Oslo
Jagiellonian University Medical College Oslo, Norway
Krakow, Poland
Giovanna Gallo
Lanfranco D’Elia Division of Cardiology
Department of Clinical Medicine and Surgery Department of Clinical and Molecular Medicine
ESH Excellence Center of Hypertension Faculty of Medicine and Psychology
“Federico II” University of Naples Medical School University of Rome Sapienza
Naples, Italy Sant’Andrea Hospital
Rome, Italy
Christian Delles
Institute of Cardiovascular and Medical Sciences Lorenzo Ghiadoni
BHF Glasgow Cardiovascular Research Centre Department of Clinical and Experimental Medicine
University of Glasgow University of Pisa
Glasgow, Scotland, United Kingdom Pisa, Italy

Ileana Desormais Cristina Giannattasio

Dipartimento Cardiotoracovascolare “De Gasperis”
Department of Thoracic and Vascular Surgery
Università Milano-Bicocca
University Hospital of Limoges
Niguarda Hospital
Limoges, France
Milan, Italy
Kyriakos Dimitriadis Guido Grassi
First Cardiology Clinic
Clinica Medica
Medical School
Department of Medicine and Surgery
National and Kapodistrian University of Athens
University of Milano-Bicocca
Hippokration Hospital
Milan, Italy
Athens, Greece
Martin Hausberg
Eamon Dolan Department of Medicine I
Connolly Hospital Karlsruhe General Hospital
Dublin, Ireland Karlsruhe, Germany

Mónica Doménech Anthony M. Heagerty

Hypertension and Vascular Risk Unit Division of Cardiovascular Sciences
Department of Internal Medicine The University of Manchester
Hospital Clínic (IDIBAPS) Manchester, United Kingdom
University of Barcelona
Barcelona, Spain Dagmara Hering
Department of Hypertension and Diabetology
Anna F. Dominiczak Medical University of Gdansk
Institute of Cardiovascular and Medical Sciences Gdansk, Poland
University of Glasgow
Glasgow, Scotland, United Kingdom Louis Hofstetter
Department of Cardiology and Clinical Research
Michael Doumas Inselspital
2nd Propedeutic Department of Internal Medicine University of Bern
Aristotle University Bern, Switzerland
Thessaloniki, Greece
Andrzej Januszewicz
Graeme Eisenhofer Department of Hypertension
Institute of Clinical Chemistry and Laboratory Institute of Cardiology
Medicine Warsaw, Poland
Department of Internal Medicine III
University Hospital Carl Gustav Carus Bojan Jelaković
Technische Universität Dresden University of Zagreb
Dresden, Germany School of Medicine
and
Stefan Engeli Department of Nephrology, Hypertension, Dialysis and
Institute of Clinical Pharmacology Transplantation
Medical School Hannover University Hospital Center
Hannover, Germany Zagreb, Croatia
 xvi Contributors

Jens Jordan Reinhold Kreutz

Institute of Aerospace Medicine Institut für Klinische Pharmakologie und Toxikologie
German Aerospace Center Charité – Universitätsmedizin Berlin
University Hypertension Center Berlin, Germany
University of Cologne
Cologne, Germany Stéphane Laurent
Department of Pharmacology
Thomas Kahan Hôpital Européen Georges Pompidou
Karolinska Institutet Université Paris – Descartes
Department of Clinical Sciences Assistance – Publique Hôpitaux de Paris
Department of Cardiology Paris, France
Danderyd University Hospital
Stockholm, Sweden Peter W. de Leeuw
Department of Medicine
M.S. Kallistratos Maastricht University Medical Center
Cardiology Department Maastricht, The Netherlands
Asklepieion General Hospital
Voula, Hellas Jacques W.M. Lenders
Department of Internal Medicine
Alex Kasiakogias Radboud University Medical Center
First Cardiology Clinic Nijmegen, The Netherlands
Medical School and
National and Kapodistrian University of Athens Department of Medicine III
Hippokration Hospital University Hospital Carl Gustav Carus
Athens, Greece Technische Universität Dresden
Dresden, Germany
Mary Kerins
Cardiac Rehabilitation Giovanna Leoncini
St James’s Hospital University of Genoa and IRCCS Policlinico
Dublin, Ireland San Martino – IST
Viale Benedetto XV
Genoa, Italy
Sverre E. Kjeldsen
Faculty of Medicine
Gregory Y.H. Lip
University of Oslo
Institute of Cardiovascular Sciences
and
University of Birmingham
Department of Cardiology
Birmingham, England, United Kingdom
Oslo University Hospital
Oslo, Norway
Melvin D. Lobo
Barts BP Centre of Excellence
Anastasios Kollias Barts Heart Centre
University Academic Fellow St Bartholomew’s Hospital
Hypertension Center STRIDE-7 and
School of Medicine Barts NIHR Cardiovascular Biomedical
National and Kapodistrian University of Athens Research Unit
Third Department of Medicine Charterhouse Square
Sotiria Hospital William Harvey Research Institute
Athens, Greece Queen Mary University London
London, United Kingdom
Eleni Koroboki
Department of Clinical Therapeutics Alexandra Hospital Aurélien Lorthioir
National and Kapodistrian University of Athens Medical Hypertension Unit
School Hôpital Européen Georges Pompidou and Paris – Descartes
Athens, Greece University
Paris, France
Vasilios Kotsis
3rd Department of Internal Medicine Charalampos Loutradis
Hypertension-24h ABPM ESH Center of Excellence Hypertension Unit
Papageorgiou Hospital Department of Nephrology
Aristotle University of Thessaloniki Aristotle University of Thessaloniki
Thessaloniki, Greece Thessaloniki, Greece
 Contributors xvii

Per Lund-Johansen Komal Marwaha

Faculty of Medicine and Dentistry College of Integrative Medicine and Department of
Institute of Medicine (K2) Physiology and Health
University of Bergen Maharishi University of Management
Bergen, Norway Fairfield, Iowa

Empar Lurbe
Stefano Masi
Pediatric Department
Department of Clinical and Experimental
Consorcio Hospital General
Medicine
University of Valencia
University of Pisa
Valencia, Spain
Pisa, Italy
and
CIBER Fisiopatología Obesidad y Nutrición
Instituto de Salud Carlos III Richard McManus
Madrid, Spain Nuffield Department of Primary Care Health Sciences
University of Oxford
Thomas F. Luscher Oxford, United Kingdom
Royal Brompton and Harefield Hospital Trust and Imperial
College Franz H. Messerli
London, United Kingdom University of Bern
Bern, Switzerland
Anne-Marie Madjalian
and
Hypertension Unit
Mount Sinai Icahn School of Medicine
Hôpital Européen Georges Pompidou and Paris – Descartes
New York, New York
University
and
Paris, France
Jagiellonian University
Felix Mahfoud Krakow, Poland
Internal Medicine III Clinic
Cardiology, Angiology and Internal Intensive Care Medicine Augusto C. Montezano
Saarland University Hospital Institute of Cardiovascular and Medical Sciences
Homburg, Germany BHF Glasgow Cardiovascular Research Centre
University of Glasgow
Giuseppe Mancia Glasgow, Scotland, United Kingdom
University of Milano-Bicocca
Milan and Policlinico di Monza
Monza, Italy Alberto Morganti
Centro Fisiologia e Ipertensione
Efstathios Manios Ospedale Policlinico
National and Kapodistrian University of Athens University of Milan
Medical School Milan, Italy
Department of Clinical Therapeutics
Alexandra Hospital Maria Lorenza Muiesan
Athens, Greece Department of Clinical and Experimental Sciences
University of Brescia
A.J. Manolis
Brescia, Italy
Cardiology Department
Asklepieion General Hospital
Voula, Hellas M. Mulvany
Department of Pharmacology
Julian E. Mariampillai University of Aarhus
Department of Cardiology Aarhus, Denmark
Oslo University Hospital
Oslo, Norway
Krzysztof Narkiewicz
Fernando Martinez Department of Hypertension and Diabetology
Hypertension Clinic, Internal Medicine Medical University of Gdansk
Hospital Clinico and INCLIVA Research Institute Gdansk, Poland
University of Valencia
Valencia, Spain Peter M. Nilsson
and Department of Clinical Sciences
CIBERObn Health Institute Carlos III Lund University
University of Valencia Skåne University Hospital
Madrid, Spain Malmö, Sweden
 xviii Contributors

Eoin O’Brien Roberto Pontremoli

The Conway Institute University of Genoa and IRCCS Policlinico San
University College Martino – IST
Dublin, Ireland Viale Benedetto XV
Genoa, Italy
Juan Eugenio Ochoa
Istituto Auxologico Italiano L.E. Poulimenos
Department of Cardiovascular Neural and Metabolic Cardiology Department
Sciences Asklepieion General Hospital
Milan, Italy Voula, Hellas, Greece

Per Omvik Aleksander Prejbisz

Faculty of Medicine and Dentistry Department of Hypertension
Institute of Medicine Institute of Cardiology
University of Bergen Warsaw, Poland
Bergen, Norway

Athanase D. Protogerou
Sandosh Padmanabhan Cardiovascular Prevention and Research Unit
Institute of Cardiovascular and Medical Clinic and Laboratory of Pathophysiology
Sciences Department of Medicine
Glasgow, Scotland, United Kingdom National and Kapodistrian University of Athens
Athens, Greece
Anna Paini
Department of Medicine Theodora Psaltopoulou
ASST Spedali Civili
Medical School
University Hospital
National and Kapodistrian University of Athens
Brescia, Italy
Athens, Greece

Paolo Palatini
Karl Heinz Rahn
Department of Medicine
Department of Medicine D
University of Padova
University of Muenster
Padua, Italy
Muenster, Germany

Vassilios Papademetriou
Interventional Hypertension and Vascular Medicine Gianpaolo Reboldi
Program Department of Medicine
VA Medical Center University of Perugia
Georgetown University Perugia, Italy
Washington, DC
Josep Redon
Gianfranco Parati Hypertension Clinic, Internal Medicine
Istituto Auxologico Italiano Hospital Clinico and INCLIVA Research Institute
Department of Cardiovascular Neural and Metabolic University of Valencia
Sciences Valencia, Spain
and and
Department of Medicine and Surgery CIBERObn Health Institute Carlos III
University of Milano-Bicocca University of Valencia
Milan, Italy Madrid, Spain

Gernot Pichler Pau Redon

Hypertension Clinic, Internal Medicine Pediatric Department
Hospital Clinico and INCLIVA Research Institute Consorcio Hospital General
University of Valencia University of Valencia
Valencia, Spain Valencia, Spain
and and
CIBERObn Health Institute Carlos III CIBER Fisiopatología Obesidad y Nutrición
University of Valencia Instituto de Salud Carlos III
Madrid, Spain Madrid, Spain
 Contributors xix

Francisco J. Rios Roland E. Schmieder

Institute of Cardiovascular and Medical Sciences Department of Nephrology and Hypertension
BHF Glasgow Cardiovascular Research Centre Friedrich Alexander University
University of Glasgow Erlangen-Nuremberg (FAU)
Glasgow, Scotland, United Kingdom Erlangen, Germany

Damiano Rizzoni Robert H. Schneider

Clinica Medica College of Integrative Medicine and Department of
Department of Clinical and Experimental Sciences Physiology and Health
University of Brescia Maharishi University of Management
Brescia, Italy Fairfield, Iowa

Claudia Agabiti Rosei Gino Seravalle

Department of Medicine Cardiology Department
ASST Spedali Civili IRCCS S. Luca Hospital
University Hospital Istituto Auxologico Italiano
Brescia, Italy Milan, Italy

Gian Paolo Rossi Theodoros N. Sergentanis

Clinica dell’Ipertensione Arteriosa Department of Clinical Therapeutics
Department of Medicine, DIMED “Alexandra” Hospital
University of Padova Medical School
Padova, Italy National and Kapodistrian University of Athens
Athens, Greece
Luis M. Ruilope
Public Health and Preventive Medicine Department
Evgeny Shlyakhto
of the Autonoma University
Federal Almazov North-West Medical Research Centre
Madrid, Spain
Russian Society of Cardiology
St. Petersburg, Russian Federation
Gurvinder Rull
Barts BP Centre of Excellence
James E. Sharman
Barts Heart Centre
Menzies Institute for Medical Research
St Bartholomew’s Hospital
College of Health and Medicine
and
University of Tasmania
Barts NIHR Cardiovascular Biomedical Research Unit
Hobart, Tasmania, Australia
Charterhouse Square
William Harvey Research Institute
Queen Mary University London Cristina Sierra
London, United Kingdom Hypertension and Vascular Risk Unit
Department of Internal Medicine
Frank Ruschitzka Hospital Clinic, IDIBAPS
Department of Cardiology University of Barcelona
University Heart Center Barcelona, Spain
Zurich, Switzerland
Nikitas Alexander P. Skliros
Michel E. Safar Cardiovascular Prevention and Research Unit
Hôtel-Dieu de Paris Clinic and Laboratory of Pathophysiology
Assistance – Publique, Hôpitaux de Paris Department of Medicine
Paris, France National and Kapodistrian University of Athens
Athens, Greece
Massimo Salvetti
Department of Clinical and Experimental Sciences Per Torger Skretteberg
University of Brescia Department of Cardiology
Brescia, Italy Oslo University Hospital
Ullevaal, Oslo, Norway
Pantelis Sarafidis
Hypertension Unit Giovanni de Simone
Department of Nephrology Hypertension Research Center
Hippokration Hospital Department of Advanced Biomedical Sciences
Aristotle University of Thessaloniki Federico II University Hospital
Thessaloniki, Greece Napoli, Italy
 xx Contributors

Wilko Spiering Giuliano Tocci

Department of Vascular Medicine Division of Cardiology
University Medical Center Utrecht Department of Clinical and Molecular Medicine
Utrecht University Faculty of Medicine and Psychology
Utrecht, The Netherlands University of Rome Sapienza
Sant’Andrea Hospital
Jan Staessen Rome, Italy
Studies Coordinating Centre and
Research Unit Hypertension and Cardiovascular IRCCS Neuromed
Epidemiology Pozzilli (IS), Italy
KU Leuven Department of Cardiovascular Sciences
University of Leuven Rhian M. Touyz
Leuven, Belgium Institute of Cardiovascular and Medical Sciences
BHF Glasgow Cardiovascular Research Centre
Konstantinos Stavropoulos University of Glasgow
2nd Propedeutic Department of Internal Medicine Glasgow, Scotland, United Kingdom
Aristotle University
Thessaloniki, Greece Monica Trapasso
Department of Medicine
University of Perugia
Ulrike M. Steckelings Perugia, Italy
IMM – Department of Cardiovascular and Renal
Research
Konstantinos P. Tsioufis
University of Southern Denmark
National and Kapodistrian University of Athens
Odense, Denmark
Hippokration Hospital
Athens, Greece
George S. Stergiou
Hypertension Center STRIDE-7 Thomas Unger
School of Medicine CARIM School for Cardiovascular Diseases
National and Kapodistrian University of Athens Maastricht University
Third Department of Medicine Maastricht, The Netherlands
Sotiria Hospital
Athens, Greece Konstantinos Vemmos
Hellenic Cardiovascular Research Society
Katarzyna Stolarz-Skrzypek Athens, Greece
1st Department of Cardiology
Interventional Electrocardiology and Hypertension Paolo Verdecchia
Jagiellonian University Medical College Department of Internal Medicine
Krakow, Poland Hospital of Assisi
Assisi, Italy
Pasquale Strazzullo
Department of Clinical Medicine and Surgery Francesca Viazzi
ESH Excellence Center of Hypertension University of Genoa and IRCCS Policlinico
“Federico II” University of Naples Medical School San Martino – IST
Naples, Italy Viale Benedetto XV
Genoa, Italy
H. Struijker-Boudier
Agostino Virdis
Department of Pharmacology and Toxicology
Department of Clinical and Experimental Medicine
Cardiovascular Research Institute
University of Pisa
Maastricht University
Pisa, Italy
Maastricht, The Netherlands
Massimo Volpe
Stefano Taddei Division of Cardiology
Department of Clinical and Experimental Medicine Department of Clinical and Molecular Medicine
University of Pisa Faculty of Medicine and Psychology
Pisa, Italy University of Rome Sapienza
Sant’Andrea Hospital
Costas Thomopoulos Rome, Italy
Department of Cardiology and
Helena Venizelou Hospital IRCCS Neuromed
Athens, Greece Pozzilli (IS), Italy
 Contributors xxi

Andrzej Więcek Jacek Wolf

Department of Nephrology, Transplantation and Department of Hypertension and Diabetology
Internal Medicine Medical University of Gdansk
Medical University of Silesia Gdansk, Poland
Katowice, Poland
Alberto Zanchetti (Late)
Bryan Williams Scientific Direction
NIHR University College London Hospitals Istituto Auxologico Italiano IRCCS
Biomedical Research Centre and
University College London Hospitals NHS Centro Interuniversitario di Fisiologia Clinica e Ipertensione
Foundation Trust Università degli Studi di Milano
London, United Kingdom Milan, Italy
 Introduction

We are delighted to present to doctors and students of the beneficial effects of antihypertensive treatment in vir-
hypertension and related cardiovascular diseases the third tually all hypertension phenotypes well ahead of a simi-
edition of the Manual of Hypertension of the European Society lar achievement in diabetes or dyslipidemias. Yet, several
of Hypertension. As in the previous editions, the epidemi- important problems remain unresolved, above all the fact
ological, pathophysiological, diagnostic and treatment that, despite the availability of a large number of effective
aspects of hypertension are addressed in detail by recog- antihypertensive drugs and drug combinations, blood
nized experts in this important area of medicine. This pressure control by treatment remains disappointingly
edition of the Manual, however, also includes chapters on low, which keeps hypertension still the most important
the emerging aspects of hypertension which are of great cause of mortality worldwide. This depends on the barri-
current interest, either because of the mechanistic, diag- ers to effectiveness of treatment that characterize clinical
nostic and treatment openings provided by basic and clini- practice, such as low adherence to the prescribed treatment
cal research, or because results are somewhat inconsistent regimen and therapeutic inertia. As the readers will see,
or even controversial, leading to differences in opinion this is the object of great attention in the Manual, which
within the medical community. devotes much more space than in the past to the problems
The recent hypertension guidelines of the European posed by real-life hypertension management as well as by
Society of Cardiology and the European Society of the optimization of the follow-up of treated hypertensive
Hypertension are also included to provide the reader less individuals.
interested in research details and more in the daily manage- We express our deep gratitude to the authors of the
ment of the high blood pressure condition with informa- chapters for the time and effort they have devoted to this
tion on how to deal with hypertension in clinical practice. book, as well as for the scientific excellence of their contri-
Hypertension represents a success story for modern butions. We are sure that this will make the Manual useful
medicine. Although the causes of the blood pressure and pleasant reading.
elevation remain in most individual patients almost as
obscure in the third millennium as they were a century Giuseppe Mancia
ago, mechanistic research has allowed us to discover most Guido Grassi
of the systems involved in cardiovascular control known Konstantinos P. Tsioufis
today, while clinical hypertension research has pioneered Anna F. Dominiczak
the era of randomized outcome-based trials, documenting Enrico Agabiti Rosei
 Section I
Background and Epidemiology
 HISTORY OF THE EUROPEAN
SOCIETY OF HYPERTENSION: 1
PAST, PRESENT AND FUTURE

Konstantinos P. Tsioufis and Enrico Agabiti Rosei

During the 1990s, it would be clear that the ESH was an

INTRODUCTION ever-growing society. The biennial meetings received an
The European Society of Hypertension (ESH) is the lead- increasing number of abstracts and participants, reaching
ing European platform for scientific exchange in hyperten- the impressive numbers of up to 1160 and 4340, respec-
sion. The society is committed to excellence in research, tively, in 1999. Attendees were from throughout Europe as
education and clinical practice in hypertension and car- well as the Americas, Asia, the Middle East and North Africa.
diovascular prevention with an aim to reduce hyperten- In 1999, it was thus decided that the ESH meeting would be
sion-induced morbidity and mortality. held annually and in larger premises than the dazzling but
The history of the ESH spans more than three decades, relatively small University of Milan (established in 1915);
and its coming of age has coincided with the great progress meetings were subsequently to be held in other European
in research and clinical management of the complex entity cities (starting with Göteborg in 2000) and in Milan every
that hypertension has proven to be (1). The first seeds second year.
of the ESH were planted in the 1980s. At that time, the By 2018, the ESH has grown to be a large network
International Society of Hypertension (ISH) encouraged with a meticulously defined infrastructure. The latter
the development of parallel activities in Europe. A group includes the ESH council board comprising of execu-
of hypertension experts led by Professor Alberto Zanchetti tive officers and members, as well as active working
coordinated European Hypertension Meetings in Milan groups and associated hypertension societies and centres
(the so-called ‘Milan Meetings’) in the years that the ISH throughout Europe and other continents (Table 1.1). The
did not hold its biennial meetings. The first meeting, orga- year of this writing (24 March 2018), Professor Alberto
nized by a European programme committee led by Alberto Zanchetti passed away at the age of almost 92 years. As
Zanchetti and Giuseppe Mancia as secretary, took place in it was written by G. Mancia in his memoriam on behalf
the historic University of Milan during 29th May–1st June of all Professor Zanchetti’s pupils, Alberto Zanchetti will
1983. The meeting was met with enthusiasm, evident from remain in memory as a great scientist and a great man. He
the large number of abstracts received and the impressive was instrumental in the creation and growth of ESH, he
number of experts from 40 attending countries. Two more was the originator and organizer of many ESH meetings,
meetings followed (in 1985 and 1987), again with great suc- and he was the driving force, behind the European hyper-
cess. The profound interest in these meetings to exchange tension guidelines.
knowledge in clinical hypertension research was the trigger
for an official European organization for hypertension.
The official birthdate of the ESH took place in 24, ACTIVITIES AND TRAINING
February, 1989. It was then that European hyperten-
sion experts established the organization, with Professor
Willem Birkenhäger (1927–2013) being the first ESH presi- ANNUAL MEETING ON HYPERTENSION
dent. The 4th European Hypertension Meeting, in Milan
on 18–21 June 1989, was the first to be organized under It is evident that the history of the annual meetings of
the auspices of the ESH. the ESH has been strongly intertwined with the course of
The ESH may safely be regarded as the young sibling of the the organization itself. The meetings offer a high-quality
ISH. The regulations and aim are similar; European mem- opportunity for attendees to be exposed to the latest basic
bers of the ISH would also be members of the ESH, and the and clinical research as well as clinical practice updates
two societies would share at different times the same experts in hypertension. Multiple teaching sessions, state-of-the-
in their respective scientific boards. Notably, the Journal of art lectures, poster and oral abstract presentation sessions
Hypertension is the official journal of both the ESH and ISH. comprise the scientific programmes. Pre- and post-ESH
 4 Manual of Hypertension of the European Society of Hypertension

Summer School started in 1995, its predecessor being a sum-

Table 1.1 Structure of the ESH
mer school organized by the German Hypertension Society
ESH Council Board in Heidelberg in 1991. Targeted towards younger candidates−
preferably below 40 years of age−devoted to hypertension
35 ESH Affiliated National Hypertension Societies basic research or clinical practice, the ESH Summer School
provides a unique combination of educational sessions from
5 ESH Associated National Hypertension Societies international experts, opportunity for social networking and
191 ESH Excellence Centres – 179 in Europe/12 in non-European
exposure to beautiful destinations across Europe.
countries For more experienced scientists, the ESH also orga-
nizes advanced courses on hypertension for certified
1069 ESH Hypertension Specialists in 49 countries European hypertension specialists or those who wish to
become so in the near future. Educational master courses
12 ESH Working Groups for hypertension leaders are also held to present and
analyse all recent progress in hypertension and cardio-
vascular prevention.
meeting satellite symposiums are also offered around
Europe to provide further knowledge on topics of general
and special interest.
THE WEB PORTAL AND APPLICATIONS
The ESH Web portal was presented in the ESH annual
WORKING GROUPS meeting in Milan in 2001 as a means to support the activ-
ities of the ESH and to present all things relevant to the
There are 12 Working Groups of the ESH that have been society through the rapidly growing worldwide web. Today,
created for the study of specific topics in the fields of the website www.eshonline.org provides all needed infor-
experimental and clinical hypertension (Table 1.2). Their mation regarding the ESH organization, the activities of
purposes are to gather and communicate scientific infor- the working groups and its scientific sessions, and also has
mation, to promote and organise research and to establish direct access to guidelines, newsletters and other scientific
specific recommendations. Comprising of a chairman, a material. Most importantly, its e-learning platform offers
secretary and members including experienced scientists selected educational resources to both ESH members as
and young investigators, the ESH Working Groups are well as non-members, including self-assessment programs.
principal contributors to the activities of the Society by In the attempt to improve doctor-patient interaction and
proposing subjects for scientific research and by initiating to increase awareness on hypertension and its associated
multicentre studies requiring the cooperation of university risks, the ESH in collaboration with the Italian Society of
and non-university centres in Europe. Hypertension has published a dedicated application for
smartphones and tablets. This application, ESH CARE,
can be found at the ESH portal and is the only application
SUMMER SCHOOLS AND COURSES on hypertension currently validated and supported by the
European Society of Hypertension.
As education is a primary target of the ESH, a number of edu-
cational activities deserve specific mention. Firstly, The ESH
HYPERTENSION SPECIALIST PROGRAMME

Table 1.2 Working Groups of the ESH The ESH Hypertension Specialist Programme was started in
2000 aimed towards hypertension specialists in Europe, to
On blood pressure in children and adolescents further enhance their expertise and eventually to improve
hypertension management in European countries. The
On blood pressure monitoring and cardiovascular variability
ESH specialists should be members of the ESH, having
On Endocrine hypertension clinical experience in difficult hypertension, documented
recognized scientific activity and continuous interest in
On endothelins and endothelial factors hypertension. More than 1000 ESH Specialists have been
approved following nominations by national societies.
On hypertension and the brain

On hypertension and the heart

CENTRES OF EXCELLENCE
On hypertension and the kidney
In 2005 the concept of the ESH Centres of Excellence was
On hypertension and sexual dysfunction
conceived to identify institutions that by definition provide
On hypertension, thrombosis and arrhythmias ‘the highest level of both inpatient and outpatient hyperten-
sion care, including surgical and vascular interventions, and
On interventional treatment of hypertension assessment of global cardiovascular risk’. There has been a
significant increase of centres through the years and there
On obesity diabetes and the high-risk patient are currently 191 ESH Centres of Excellence in 36 European
On vascular structure and function
countries, and associated centres in 7 non-European coun-
tries (Australia, Bahrain, Brazil, Israel, Lebanon, People’s
Index advantage of

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