2024 ESC Guidelines for the management of elevated blood pressure and hypertension: Key Points
- Title Update: The guidelines have shifted from “arterial hypertension” to “elevated blood pressure (BP) and hypertension” to reflect the continuous risk of cardiovascular disease (CVD) associated with BP levels [3].
- New BP Classification: A new category, “elevated BP,” is defined as systolic BP 120–139 mmHg or diastolic BP 70–89 mmHg, while hypertension remains defined as systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg [3].
- Target BP Recommendation: The target systolic BP for adults on BP-lowering medications is now recommended to be 120–129 mmHg, a significant change from previous guidelines [2].
- Treatment Approach: Most patients should be treated to the new target range initially, rather than first targeting <140/90 mmHg as in earlier guidelines [5].
- Lifestyle First: For individuals with elevated BP, a 3-month lifestyle modification is recommended before considering medication, especially for those with high CVD risk [3].
- Older Adults: Treatment guidelines for elevated BP and hypertension in older patients (<85 years) who are not frail should align with those for younger patients, ensuring tolerability of treatment [3].
- CVD Outcomes Focus: A Class I recommendation for interventions must now demonstrate a benefit on CVD outcomes, rather than solely on BP reduction [2].
- Sex and Gender Consideration: The new guidelines incorporate biological sex and sociocultural gender as important factors influencing hypertension management [3]
