p.10 抽出テキスト

7 Diagnosing hypertension and investigating underlying causes

Opportunistic screening for elevated BP and hypertension should be considered: • At least every 3 years for adults aged <40 years. • At least annually for adults aged ≥40 years. IIa C In individuals with elevated BP who do not currently meet risk thresholds for BP-lowering treatment, a repeat BP measurement and risk assessment within 1 year should be considered. IIa C Other forms of screening for hypertension (i.e. systematic screening, self-screening, and non-physician screening) may be considered, depending on their feasibility in different countries and healthcare systems. IIb B In individuals with increased CVD risk where their screening office BP is 120–139/70–89 mmHg, it is recommended to measure BP out of office, using ABPM and/or HBPM or, if not logistically feasible, make repeated office BP measurements on more than one visit. I B Objective evaluation of adherence (either directly observed treatment or detecting prescribed drugs in blood or urine samples) should be considered in the clinical work-up of patients with apparent resistant hypertension, if resources allow. IIa B If moderate-to-severe CKD is diagnosed, it is recommended to repeat measurements of serum creatinine, eGFR, and urine ACR at least annually. I C Coronary artery calcium scoring may be considered in patients with elevated BP or hypertension when it is likely to change patient management. IIb B Patients with resistant hypertension should be considered for referral to clinical centres with expertise in hypertension management for further testing. IIa B It is recommended that patients with hypertension presenting with suggestive signs, symptoms, or medical history of secondary hypertension are appropriately screened for secondary hypertension. I B Screening for primary aldosteronism by renin and aldosterone measurements should be considered in all adults with confirmed hypertension (BP ≥ 140/90 mmHg). IIa B

8 Preventing and treating elevated blood pressure

Opportunistic screening with office BP measurements to monitor development of BP during late childhood and adolescence, especially if one or both parents have hypertension, should be considered to better predict development of adult hypertension and associated CVD risk. IIa B It is recommended to restrict free sugar consumption, in particular sugar-sweetened beverages, to a maximum of 10% of energy intake. It is also recommended to discourage consumption of sugar-sweetened beverages, such as soft drinks and fruit juices, starting at young age. I B In patients with hypertension without moderate-to-advanced CKD and with high daily sodium intake, an increase of potassium intake by 0.5–1.0 g/day—for example through sodium substitution with potassium-enriched salt (comprising 75% sodium chloride and 25% potassium chloride) or through diets rich in fruits and vegetables—should be considered. IIa A In patients with CKD or taking potassium-sparing medication, such as some diuretics, ACE inhibitors, ARBs, or spironolactone, monitoring serum levels of potassium should be considered if dietary potassium is being increased. IIa C It is recommended to take medications at the most convenient time of day for the patient, to establish a habitual pattern of medication taking to improve adherence. I B In adults with elevated BP and low/medium CVD risk (<10% over 10 years), BP lowering with lifestyle measures is recommended and can reduce the risk of CVD. I B In adults with elevated BP and sufficiently high CVD risk, after 3 months of lifestyle intervention, BP lowering with pharmacological treatment is recommended for those with confirmed BP ≥130/80 mmHg to reduce CVD risk. I A It is recommended that in hypertensive patients with confirmed BP ≥140/90 mmHg, irrespective of CVD risk, lifestyle measures and pharmacological BP-lowering treatment is initiated promptly to reduce CVD risk. I A It is recommended to maintain BP-lowering drug treatment lifelong, even beyond the age of 85 years, if well tolerated. I A Because the benefit in reducing CVD outcomes is uncertain in these settings, and noting that close monitoring of treatment tolerance is advised, BP-lowering treatment should only be considered from ≥140/90 mmHg (office) among persons meeting the following criteria: • pre-treatment symptomatic orthostatic hypotension; • age ≥85 years; • clinically significant moderate-to-severe frailty; • and/or limited predicted lifespan (<3 years). IIa B In cases where BP-lowering treatment is poorly tolerated and achieving a target systolic of 120–129 mmHg is not possible, it is recommended to target a systolic BP level that is ‘as low as reasonably achievable’ (ALARA principle). I A Once BP is controlled and stable under BP-lowering therapy, at least a yearly follow-up for BP and other CVD risk factors should be considered. IIa C

Continued

ESC Guidelines                                                                                                                                                                                          3921

Downloaded from academic.oup.com/eurheartj/article/45/38/3912/7741010 by guest on 07 October 2026