Besondere Bluthochdruckfälle: Leitlinienempfehlungen der European Society of Cardiology und European Society of Hypertension [Special cases of high blood pressure: Guideline recommendations of the European Society of Cardiology and European Society of Hy

In 2013 the new European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines for the treatment of arterial hypertension were published. The focus in these new guidelines is the treatment of hypertensive patients under special conditions. Particular attention is paid, for instance to the treatment of white coat hypertension and masked hypertension. Older patients, the so-called octogenarians benefit from antihypertensive treatment but with a higher target blood pressure. Women in childbearing years should avoid blockers of the renin-angiotensin system due to the potential teratogenic effects of these substances. An antihypertensive therapy with methyldopa, labetalol or nifedipin should be initiated in pregnant women when the blood pressure is over 160/110 mmHg. A decrease of blood pressure to less than 130/80 mmHg does not bring benefits for patients with diabetes mellitus or renal failure. In cases of concomitant proteinuria, systolic target values of 130 mmHg can be considered. An antihypertensive treatment is not recommended in acute stroke but must be weighed against the clinical situation. Blood pressure in patients with coronary heart disease should not be below 120/70 mmHg due to an increase in cardiovascular morbidity and mortality. Therapeutic alternatives in patients with resistant hypertension are mineralocorticoid receptor blockers, the alpha blocker doxazosin or an intensified diuretic therapy, for example as a sequential blockade of nephrons.