S2k Guidelines for Patient Management

Understanding S2k Guidelines

The German Association of the Scientific Medical Societies (AWMF) classifies guidelines as S2k, which indicates development through a formal consensus method with a representative panel of experts, and is more rigorous than S1 guidelines but less rigorous than S2e or S3 guidelines 1

The American Journal of Kidney Diseases recommends that patients with diabetes, kidney, or cardiovascular disease stop taking certain medications, including SGLT2 inhibitors, NSAIDs, potassium-sparing diuretics, loop diuretics, ACE inhibitors/ARBs, and thiazide/thiazide-like diuretics, during acute illness 2
Trigger symptoms for implementing sick day medication guidance include vomiting or diarrhea resulting in significant fluid losses, anorexia or nausea causing significant decrease in fluid intake, and new lightheadedness, dizziness, or fainting 2
The duration of medication hold should be up to 3 days or until symptoms resolve, and patients should resume medications at usual doses within 24-48 hours of eating and drinking normally 2

Emergency medical service providers should transport the patient's backup and peripheral equipment, and use a Doppler probe and manual cuff to obtain blood pressure, for patients with mechanical circulatory support devices 3

The International Society of Hypertension recommends that office BP ≥140/90 mmHg indicates hypertension, particularly if home BP ≥135/85 mmHg or 24h ambulatory BP ≥130/80 mmHg 4, 5
For Grade 1 hypertension (140-159/90-99 mmHg), the International Society of Hypertension recommends starting lifestyle interventions and drug treatment in high-risk patients or after 3-6 months of lifestyle intervention in others 4, 6
The target blood pressure reduction is at least 20/10 mmHg, ideally to <130/80 mmHg, individualized for elderly based on frailty 4, 5

The European Society of Cardiology recommends lifestyle counselling, including vaccination against influenza, pneumococcal disease, and other widespread infections, treatment of sleep-related breathing disorders, avoidance of psychosocial stress, and smoking cessation with pharmacological and behavioral strategies 7
The European Society of Cardiology recommends risk factor targets, including LDL-C goal <1.4 mmol/L (55 mg/dL) and ≥50% reduction from baseline, HbA1c <7.0% (53 mmol/mol), SBP 120-129 mmHg if well tolerated, and a Mediterranean diet high in vegetables, fruits, and wholegrains 7

The German Association of the Scientific Medical Societies (AWMF) notes that S2k guidelines may vary in quality and rigor compared to S3 guidelines, which include both formal consensus and systematic evidence review 1
The European Society of Cardiology emphasizes that patient education is essential for adherence to guideline recommendations 7
The American Journal of Kidney Diseases recommends that medication adjustments during acute illness should be time-limited and patients should be instructed when to seek medical help 2
The European Heart Journal notes that guidelines should be applied with consideration of individual patient circumstances and preferences 8