array:22 [ "pii" => "S1889183724000151" "issn" => "18891837" "doi" => "10.1016/j.hipert.2024.02.004" "estado" => "S300" "fechaPublicacion" => "2024-01-01" "aid" => "551" "copyright" => "SEH-LELHA" "copyrightAnyo" => "2024" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Hipertens Riesgo Vasc. 2024;41:1-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S1889183723000363" "issn" => "18891837" "doi" => "10.1016/j.hipert.2023.06.001" "estado" => "S300" "fechaPublicacion" => "2024-01-01" "aid" => "531" "copyright" => "SEH-LELHA" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Hipertens Riesgo Vasc. 2024;41:5-16" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Mortality and cardiovascular risk in vasculitis ANCA. Importance of hypertension and renal function. Experience from southern Spain" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "5" "paginaFinal" => "16" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Mortalidad y riesgo cardiovascular en vasculitis ANCA. Importancia de la hipertension y funcion renal. Experiencia del sur de España" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1706 "Ancho" => 2341 "Tamanyo" => 222046 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Survival analysis. Global survival (a, b). Age and renal function at baseline were independent predictors of mortality. Cardiovascular survival (c, d). Age and suffer from HTN 6 months after diagnosis of vasculitis were independent predictors of CVE. CVE: cardiovascular events; HTN: hypertension.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.A. Martin-Gómez, A. Rodríguez Torres, M. Espinosa Hernández, M. Lopez Mendoza, J.M. Sabio Sánchez, M. Martin Armada, I. Martin Suarez, J.L. Callejas Rubio, M.M. Castilla Castellano, J.C. Anglada Pintado, A.C. Barnosi Marín, M.D. Martinez Esteban, L. Castilla Guerra, E. De Ramón Garrido" "autores" => array:15 [ 0 => array:2 [ "nombre" => "M.A." "apellidos" => "Martin-Gómez" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Rodríguez Torres" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Espinosa Hernández" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Lopez Mendoza" ] 4 => array:2 [ "nombre" => "J.M." "apellidos" => "Sabio Sánchez" ] 5 => array:2 [ "nombre" => "M." "apellidos" => "Martin Armada" ] 6 => array:2 [ "nombre" => "I." "apellidos" => "Martin Suarez" ] 7 => array:2 [ "nombre" => "J.L." "apellidos" => "Callejas Rubio" ] 8 => array:2 [ "nombre" => "M.M." "apellidos" => "Castilla Castellano" ] 9 => array:2 [ "nombre" => "J.C." "apellidos" => "Anglada Pintado" ] 10 => array:2 [ "nombre" => "A.C." "apellidos" => "Barnosi Marín" ] 11 => array:2 [ "nombre" => "M.D." "apellidos" => "Martinez Esteban" ] 12 => array:2 [ "nombre" => "L." "apellidos" => "Castilla Guerra" ] 13 => array:2 [ "nombre" => "E." "apellidos" => "De Ramón Garrido" ] 14 => array:1 [ "colaborador" => "on behalf of the Andalusian Association of Autoimmune Diseases (AADEA) and the Andalusian Society of Arterial Hypertension (SAHTA)" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1889183723000363?idApp=UINPBA00004N" "url" => "/18891837/0000004100000001/v1_202403190601/S1889183723000363/v1_202403190601/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Comment on the update of the 2023 European Society of Hypertension (ESH) guidelines for the management of arterial hypertension" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "1" "paginaFinal" => "4" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "E. Rodilla, M. Gorostidi" "autores" => array:2 [ 0 => array:4 [ "nombre" => "E." "apellidos" => "Rodilla" "email" => array:1 [ 0 => "rodilla_enr@gva.es" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Gorostidi" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Unidad de Hipertensión y Riesgo Vascular, Hospital Universitario de Sagunto, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Comentario a la actualización de las Guías 2023 de la European Society of Hypertension (ESH) para el manejo de la Hipertensión Arterial" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1095 "Ancho" => 1550 "Tamanyo" => 87521 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Guidelines are divided into three different sections: (1) AHT bases, (2) treatment and (3) circumstances.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The 2023 European Society of Hypertension (ESH).<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> Guidelines for the Management of Arterial Hypertension have very recently been published. Our comments here address the main characteristics of this important document that, in summary, confirms the definition, objectives and treatment of arterial hypertension (HTN) of previous Guidelines, although it significantly modifies the role of beta-blockers, extends the scope of action to environmental and telemedicine factors and probes into practical aspects such as clinical phenotypes and frailty in the elderly.</p><p id="par0010" class="elsevierStylePara elsevierViewall">It should be highlighted that the publication of these Guidelines complies with the habit of updating the evidence every five years, which has been in place since the first 2003 Guidelines, although on this occasion the writing has been carried out exclusively by the ESH, and with the support of the International Society of Hypertension (ISH) and the European Renal Association (ERA).</p><p id="par0015" class="elsevierStylePara elsevierViewall">In general, there are two basic principles that coexist in the ESH 2023 Guidelines. On the one hand, the desire to not only mention the relevant studies for each recommendation, but also their extensive discussion, reasoning and justification, so that it represents an excellent instrument to support research. However, far from emulating a mere textbook, there is on the other hand a firm intention to simplify the messages in the form of highly elaborate and innovative figures, which studiously summarise the content.</p><p id="par0020" class="elsevierStylePara elsevierViewall">It is important to highlight that the model of evaluating the level of scientific evidence (A, B and C) is preserved, as well as the strength of the recommendations already used previously (I, II and III), but the difference between Class IIa (should be considered) and Class IIb (can be considered) is eliminated because this differentiation is of little use and that changes in the strength of recommendations generated much controversy in the past – for example, the recommendation to perform echocardiography among the Guidelines of 2013 (IIa) and 2018 (IIb).</p><p id="par0025" class="elsevierStylePara elsevierViewall">The Guidelines are divided into three different sections: (1) HTN Basics, (2) Treatment and (3) Settings. Each of these sections includes considerations regarding the gaps and opportunities that remain to be resolved (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The pathophysiology of blood pressure (BP) is the subject of a comprehensive analysis in the first section of the Guidelines. In comparison with previous ones, the incorporation of new areas of research stands out, such as environmental factors and the greater weight attributed to inflammation mechanisms, all consolidating a mosaic, multimechanistic and interactive model which is represented graphically.</p><p id="par0035" class="elsevierStylePara elsevierViewall">However, what undoubtedly represents the main information of these Guidelines, the classification of BP and the definition of the degree of AHT, is the same as that of 2018, i.e., it is recommended to classify BP as optimal, normal, high-normal, grade 1, grade 2 and grade 3 depending on the measurement in office. Therefore, the threshold of 140/90<span class="elsevierStyleHsp" style=""></span>mmHg is maintained, and is justified by the fact that there is no new evidence that modifies this recommendation. The definition of isolated systolic HTN persists and, as a small novelty, isolated diastolic HTN is added.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Following on from this, the normal values of ambulatory BP also remain identical, both Home Blood Pressure Measurement (HBPM) with values of 135/85<span class="elsevierStyleHsp" style=""></span>mmHg, and ambulatory BP monitoring (ABPM) with thresholds of 24<span class="elsevierStyleHsp" style=""></span>h of 130/80<span class="elsevierStyleHsp" style=""></span>mmHg, 135/85<span class="elsevierStyleHsp" style=""></span>mmHg during the day and 120/70<span class="elsevierStyleHsp" style=""></span>mmHg at night.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Regarding children and teenagers, from the age of 16 it is recommended to use the adult classification, while at younger ages BP is considered normal when values are lower than the 90th percentile, normal-high between the 90th and 95th percentile, and HTN when BP values exceed the 95th percentile. It is interesting to remember that the clinical data underlying these tables come in the case of clinical BP from a US database, and in the case of ambulatory BP in children from data collected in Germany.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Another fundamental characteristic of the 2023 HTN Guidelines that remains unchanged is the recommendation to stratify cardiovascular (CV) risk in all patients, especially in those at low or moderate risk. The concept of factors that influence CV risk is also maintained: that of Hypertension Mediated Organ Damage (HMOD), that of established CV or kidney disease, and the classification of stage 1 (HTN without complications), stage 2 (asymptomatic disease), and stage 3 (established disease).</p><p id="par0055" class="elsevierStylePara elsevierViewall">Starting with the first, it is interesting to note that the list of risk factors, maintaining the previous ones, has been expanded with laboratory variables such as Lipoprotein (a) and others such as pregnancy complications, environmental or noise pollution and migration. The importance of up to 10 comorbidities is also highlighted, some of them novel, such as long COVID or non-alcoholic fatty liver disease (NAFLD), not so much because their potential to modify CV risk was not known, but rather because they appear in a specific listing.</p><p id="par0060" class="elsevierStylePara elsevierViewall">In turn, the HMOD continues to represent a central axis of risk stratification. Also in this edition, the Guidelines distinguish subclinical cardiac, renal, arterial, cerebral and retinal lesions. At the cardiac level, left ventricular hypertrophy, determined by ECG or echocardiography, remains the main measure. Ventricular geometry and left atrial and filling pressure measurements are maintained, and global longitudinal strain (GLS) is introduced as a marker of ventricular dysfunction. At the renal level, the glomerular filtration rate and urinary albumin excretion ranges are preserved, and the renal resistive index (RRI) is included for the first time as a useful parameter. Regarding arterial damage, atherosclerosis such as increased intima media thickness (IMT) or carotid plaque without stenosis, and arterial stiffness as pulse pressure<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>mmHg or determined as pulse wave velocity (PWV), is still considered HMOD. It is only notable that the wrist-ankle PWV is added to the carotid-femoral PWV. The ankle-brachial index continues to be recommended to diagnose peripheral arterial disease, and for the study of the retina, in addition to the Keith–Wagener–Barker score, the study of the wall/lumen ratio of the retinal arterioles is included.</p><p id="par0065" class="elsevierStylePara elsevierViewall">What has not changed and persists as an IB recommendation is the usefulness of the HMOD to improve CV risk stratification. That is, subjects with low or moderate risk according to SCORE2 or SCORE2-OP who present HMOD, long-standing DM or a very high CV risk factor (e.g. cholesterol), should be placed in the high CV risk category.</p><p id="par0070" class="elsevierStylePara elsevierViewall">However, unlike previous Guidelines, and as previously mentioned, this edition does not evaluate the indication of determining each of the HMOD specifically. While other Guidelines, such as those of the ISH,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> distinguish between “basic” and “optimal” management to graduate the indication of measures such as HMOD, the ESH has opted for the expression “if available”, implying that recommending complementary tests without being available, is not useful, but that HMOD improves CV risk stratification.</p><p id="par0075" class="elsevierStylePara elsevierViewall">It is worth highlighting the importance once again attributed to the HMOD in relation to sensitivity to changes, its reproducibility, the time required and the prognostic value of the changes. The proven prognostic value of variations in urinary albumin excretion stands out especially, unlike in 2018, and which, together with changes in LVH, represent the most important HMOD.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Still in the Basics, the 2023 Guidelines correct a deficit that was already present in several editions, such as the exact description of how to measure BP in consultation, since it had not been updated since the 2003 Guides. Once again, the simplification effort is appreciated through a detailed Figure that summarises all the information. Furthermore, the need to use only validated devices is highlighted, which can be consulted at the link <a href="http://www.stridebp.org/">www.stridebp.org</a>. Given the lack of evidence, the 2023 Guidelines do not recommend measuring BP with cuffless devices without a cuff, or BP not monitored in the office. Likewise, the measurement of central BP is not indicated in clinical practice, with the exception of isolated systolic BP in young patients.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Concluding the Basics section, the 2023 Guidelines dedicate an important space to evaluating office BP in consultation, SMBP and ABPM. Despite the increase in ambulatory BP devices in clinical practice, the Guidelines, in general, revalue office BP as the main method for diagnosing HTN and insist – with recommendation I and evidence A – that it represents the technique on which the management of HTN is based. The specific indications for HBPM (long-term follow-up and adherence to treatment) and ABPM (nocturnal BP and dipping, pregnancy) are described, but their role in the diagnosis of HTN is optional and complementary, and cannot replace office BP in consultation. The Guidelines explicitly point out that there are no randomised studies that have compared the effect of treatment guided by ABPM versus that guided by BP in consultation, although with recommendation level IIB it is stated that ABPM can be considered complementary to BP in consultation by its greater reproducibility and prognostic value. Other parameters derived from ambulatory BP, such as variability, morning peak, and ambulatory arterial stiffness index, are not recommended for daily clinical practice. And there are also gaps in knowledge regarding the correct measurement and interpretation of BP data in atrial fibrillation.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Moving on to the last section of the Basics, there are no relevant developments in the section dedicated to the diagnosis of secondary ATH. Once again, a new figure stands out which both educationally and visually describes the frequent age of onset with the different types of secondary HTN. The previous definitions of malignant AHT are confirmed, but the so-called “true” resistant HTN is coined as a new concept, which requires three drugs at full doses, one of them being a thiazide diuretic, confirmation of elevated BP with HBMP or ABPM, verification of a correct adherence and the exclusion of secondary disorders, estimating a real prevalence of no more than 5%.</p><p id="par0095" class="elsevierStylePara elsevierViewall">The second section on Treatment, similarly to Diagnosis of HTN, broadly maintains the core messages of the 2018 Guidelines, with thresholds located at 140/90<span class="elsevierStyleHsp" style=""></span>mmHg, except in those over 80 years of age, in whom a systolic BP of 160<span class="elsevierStyleHsp" style=""></span>mmHg, or 140<span class="elsevierStyleHsp" style=""></span>mmHg, if well tolerated is still recommended. It begins with an important Figure that defines the indication for starting pharmacological treatment based on the combination of the degree of HTN and the presence of HMOD. In summary, healthy lifestyle measures should be initiated as soon as the diagnosis of HTN is established. Only in the absence of symptoms and HMOD, pharmacological treatment can be postponed for a few months in grade 1 HTN. In other cases, treatment is recommended. This section highlights the recommendation to use HBPM or ABPM, whenever possible.</p><p id="par0100" class="elsevierStylePara elsevierViewall">The objectives of reducing BP no further than 120/70<span class="elsevierStyleHsp" style=""></span>mmHg do not change and are visualised with a new Figure. However, while the 2018 Guidelines clearly accentuated the risks of exceeding these limits, the 2023 Guidelines relativise the lower threshold of 70<span class="elsevierStyleHsp" style=""></span>mmHg, introducing the expression “actively.” It thus clarifies a frequent and controversial situation in the practical management of HTN in people over 80 years of age, when high systolic BP is intentionally reduced and simultaneously, not “actively”, diastolic BP drops below 70<span class="elsevierStyleHsp" style=""></span>mmHg, being well tolerated. Furthermore, as an important novelty, a comprehensive table is added that explains how to properly assess frailty and the degree of functionality in patients over 80 years of age. Within the therapeutic objectives, it is also highlighted that there is no evidence of how far ambulatory BP should be reduced in ABPM.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Regarding the non-pharmacological treatment of HTN, the previous recommendations are maintained, while the revaluation of beta-blockers as first-level antihypertensives in pharmacological treatment clearly stands out. A geometric figure, in this edition a rhombus, is recovered to visualise the recommended drug combinations, including beta blockers in one of the vertices. Furthermore, the recommendation to initiate pharmacological treatment of HTN in the majority of patients with a double combination of drugs is clearly reinforced, initially at low doses, coinciding with the recommendation of the 2022<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> SEHLELHA Guidelines, and preferably in fixed combinations. It is also stated that increasing the medication to a triple combination, already described in previous Guidelines, of ACEI/ARB plus calcium antagonist plus diuretic, at full doses, can control up to 90% of patients. Once again, beta blockers are rehabilitated, placing them on one side of the corresponding Figure as monotherapy or substitute for any of the mentioned classes. Therefore, monotherapy as an initial strategy remains limited to three situations: low-risk subjects and grade 1 BP, frail patients, and very high-risk patients with high-normal BP. Another sign of recommendation for beta-blockers is found in the preparation of two new tables that bring together, on the one hand, the first-level indications, and on the other, the clinical situations of favourable use of beta-blockers.</p><p id="par0110" class="elsevierStylePara elsevierViewall">The intention to simplify treatment in different clinical situations is evident in the development of highly didactic figures for resistant HTN, chronic kidney disease (CKD), cerebrovascular disease, coronary artery disease (CAD), heart failure and atrial fibrillation. As examples in resistant HTN and CKD, the initial differentiation between a glomerular filtration rate greater or less than 30<span class="elsevierStyleHsp" style=""></span>ml/min, or the initial presence of angina in CAD, is enough to discern between alternative treatments. Diabetes mellitus deserves special mention, for whose treatment the 2023 Guidelines, in addition to setting a lower therapeutic objective, 130/80<span class="elsevierStyleHsp" style=""></span>mmHg, reinforce the use of inhibitors of the renin/angiotensin system, adding iSGLT2 and GLP-1 in obese people and finally finerenone in diabetic nephropathy.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The last section of the Guidelines includes an exhaustive list of relevant settings, i.e., differentiated scenarios that deserve special attention, divided into phenotypes, demographics and specific scenarios. Among the phenotypes, the most novel are WUCH (white-coat uncontrolled hypertension) and MUCH (masked uncontrolled hypertension) and the greater emphasis on orthostatism. In the populations under study in Demography, the recommendation of treatment in young adults, the peculiarities of HTN in women and the differences between ethnicities stand out. Within the long list of specific scenarios, the sections dedicated to the long-term risks of gestational HTN, autoimmnune diseases associated HTN, cognitive impairment, as well as oncological treatments and COVID stand out for their relevance.</p><p id="par0120" class="elsevierStylePara elsevierViewall">An exhaustive update on the monitoring of hypertensive patients and the implementation of the Guidelines themselves are also present. Lack of adherence to treatments continues to represent one of the biggest obstacles to controlling HTN. As relative novelties to improve it, it is recommended to make use of Telemedicine, as well as teamwork of all actors in the health system, including Nursing and Community Pharmacies. A final figure summarises the proposed follow-up of hypertensive subjects in four time-windows, starting with the diagnosis and the initial phase, and specifying the elements of short- and long-term follow-up.</p><p id="par0125" class="elsevierStylePara elsevierViewall">To conclude, the 2023 Guidelines represent an excellent source of reference for any topic related to HTN. They maintain the definition, thresholds and treatment objectives of previous ESH Guidelines, reinforce the essential role of subclinical target organ damage and underline the message of early and mostly combined treatment of HTN. A shortened pocket version is expected to be published soon to enable its implementation in daily clinical practice.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1095 "Ancho" => 1550 "Tamanyo" => 87521 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Guidelines are divided into three different sections: (1) AHT bases, (2) treatment and (3) circumstances.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA)" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "2023 ESH Guidelines for the management of arterial hypertension" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/HJH.0000000000003480" "Revista" => array:6 [ "tituloSerie" => "J Hypertens" "fecha" => "2023" "volumen" => "41" "paginaInicial" => "1874" "paginaFinal" => "2071" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/37345492" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "2020 international society of hypertension global hypertension practice guidelines" ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/HYPERTENSIONAHA.120.15026" "Revista" => array:6 [ "tituloSerie" => "Hypertension" "fecha" => "2020" "volumen" => "75" "paginaInicial" => "1334" "paginaFinal" => "1357" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32370572" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Guía práctica sobre el diagnóstico y tratamiento de la hipertensión arterial en España, 2022. Sociedad Española de Hipertensión – Liga Española para la Lucha contra la Hipertensión Arterial (SEH-LELHA)" ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.hipert.2022.09.002" "Revista" => array:6 [ "tituloSerie" => "Hipertensión y riesgo vascular" "fecha" => "2022" "volumen" => "39" "paginaInicial" => "174" "paginaFinal" => "194" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36153303" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/18891837/0000004100000001/v1_202403190601/S1889183724000151/v1_202403190601/en/main.assets" "Apartado" => array:4 [ "identificador" => "9102" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Editorial" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/18891837/0000004100000001/v1_202403190601/S1889183724000151/v1_202403190601/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1889183724000151?idApp=UINPBA00004N" ]
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Editorial
Comment on the update of the 2023 European Society of Hypertension (ESH) guidelines for the management of arterial hypertension
Comentario a la actualización de las Guías 2023 de la European Society of Hypertension (ESH) para el manejo de la Hipertensión Arterial