2023 Update Guidelines on Arterial Hypertension by the European Society of Hypertension (ESH)

Key messages

• The ESH has recently updated their guidelines for the management of arterial hypertension, with greater emphasis on the use of clinically validated devices¹

• Home BP monitoring with validated devices leads to better blood pressure control, whereas the use of non-validated devices with inaccurate measurements can lead to misdiagnosis⁷

What has changed for blood pressure measurements in the 2023 updated ESH Guidelines?¹

Adults

• Opportunistic screening for all adults

• Regular measurements for those >40 years or at high risk

Children

• Screening of all children <3 years old

• Screening of children >3 years old with risk factors for high blood pressure (BP) including congenital heart disease, chronic kidney disease, solid organ transplantation, treatment with BP increasing drugs, or history of preterm birth

Devices

• Only properly validated devices should be used to ensure measurements are accurate

• Automatic electronic, upper-arm cuff devices are recommended for both office and out-of-office use

• Devices with automated storage and connectivity are preferred

• Support for telehealth technologies and nocturnal BP measurements are encouraged

Home BP monitoring is recommended for:

• Providing better reproducibility and prognostic value

• Support the identification of white-coat or masked hypertension

• Improving BP control through long-term follow-up of treated hypertension

• Novel home devices could provide an alternative to ambulatory blood pressure measurement (ABPM) to measure blood pressure values during sleep to detect elevated or non-dipping blood pressure
  

Why is clinical validation of devices crucial?

Although clinical validation for accuracy is recommended by guidelines, it is not mandatory prior to bringing a blood pressure monitor (BPM) to market^3,4

Globally, less than a quarter of upper-arm devices are validated or equivalent to a validated device⁵

Non-validated devices may provide inaccurate measurements, leading to misdiagnosis and mistreatment⁷

The ESH recommends that healthcare professionals, patients, and the public should check STRIDE BP for listing of accurate devices¹

Lists of devices validated for home, office/hospital, or ambulatory use, in addition to those validated for use in children or pregnant women can be found at www.stridebp.org

STRIDE BP currently approves 390 of the >4000 devices on the market²

How are blood pressure monitors validated?

• New devices are validated by comparing their measurements to those of reference devices using protocols set out by professional societies

• A universal protocol has been developed by the US Association for the Advancement of Medical Instrumentation (AAMI), ESH, and the International Organization for Standardization (ISO)¹²

• STRIDE BP will list a device if the results of such a validation study are published as a full paper^10,11

All OMRON devices are clinically validated and listed by STRIDE BP^13,14

• OMRON ensures that every model of their BPMs meets the highest standards of precision and reliability¹³

• OMRON has 91 validated upper-arm devices listed on STRIDE BP²