Diagnostic and Therapeutic Approach to Different Hypertensive Phenotypes According to the 2023 ESH Guidelines

Abstract

The European Society of Hypertension (ESH) in the guidelines document issued in 2023 made specific recommendations regarding the diagnostic and therapeutic approach for the different hypertensive phenotypes detectable in current clinical practice. The present paper will offer a critical review of these recommendations.The clinical hypertensive phenotypes of most frequent detection in current clinical practice, namely white-coat hypertension, masked hypertension, nocturnal hypertension and isolated systolic hypertension of the elderly will be reviewed. Other less common phenotypes will be also addressed. Recommendations for each clinical phenotype are made, emphasizing the need for an accurate diagnosis and treatment for specific clinical conditions, i.e. when target organ damage and/or high cardiovascular risk is detected. Areas of uncertainty related to clinical phenotypes in which pathophysiological and prognostic information are still lacking will be discussed. Future studies will allow to refine the guidelines recommendations, particularly for the clinical conditions for which pathophysiological and prognostic information are at present scanty.

Keywords: Antihypertensive treatment; Guidelines; Hypertensive phenotypes; Isolated systolic hypertension; Nocturnal hypertension; White-coat hypertension.

Fig. 1

Scheme illustrating the recommendations made by the 2023 European Society of Hypertension guidelines for the diagnosis and treatment of the hypertensive clinical phenotypes of most frequent detection. HT: hypertension, HMOD: hypertension-mediated organ damage, CV: cardiovascular.

Fig. 2

Scheme illustrating the recommendations made by the 2023 European Society of Hypertension guidelines for the diagnosis and treatment of the hypertensive clinical phenotypes of less frequent detection. WUCH: white-coat uncontrolled hypertension, MUCH: masked uncontrolled hypertension, BP: blood pressure. Other abbreviations as in Fig. 1.