A glance at 2024 ESC Guidelines for elevated BP and hypertension management

A glance at 2024 ESC Guidelines for elevated BP and hypertension management:

What is new and How to implement?

New “Elevated BP” category

Benefit for the overlooked group under hypertension threshold

What's New: Elevated BP is defined as an office SBP/ DBP of 120–139/70–89 mmHg¹

WHY

▼ 11% CVD risk

HR=0.89 (95% CI 0.81-0.98)

Meta-analyses of RCTs: BP-lowering therapy is beneficial (major CVD events reduced by 11%; HR = 0.89 95% 0.81-0.98)

CLINICAL PRACTICE IMPLICATION

^{Class IIa, Level C}Screening for elevated BP and CVD risk assessment should be considered every 3 years ( <40yrs) or annually (>=40yrs and others).¹

^{Class I, Level A}Treatment initiation is suggested for a subgroup of elevated BP with increased risk of CVD.¹

New “Systolic BP Treatment Target”

Stronger push for ‘The lower the better, but within reason^’1,3

What's New: BP target for most HTN patients is now 120–129/70–79 mmHg¹

WHY

CLINICAL PRACTICE IMPLICATION

^{Class I, Level A}To optimize CVD risk reduction, target systolic BP at 120–129 mmHg in most adults, if well tolerated.¹

^{Class I, Level A}Reduce SBP As Low As Reasonably Achievable (ALARA) and personalize target, if optimal BP not possible^1-3

Pharmacological Interventions

Treatment should be intensive, effective and tolerable

TREATMENT THRESHOLD^1,3

Early pharmacological therapy initiation in
1. Subgroup of elevated BP (>=130/80 mmHg) with increased CVD risk.
2. Hypertension threshold (BP>=140/90 mmHg regardless of age)

TREATMENT STRATEGIES FOR PRACTICE

First-line recommended therapies:
Including the major first-line drug classes (ARB, CCB, diuretics) in the guidelines.¹

Single-Pill Combinations (SPC) for better adherence:
Aligning with guideline emphasis on simplifying regimens to achieve BP control.¹

Robust cardiorenal protection evidence:
Supported by extensive CV and renal clinical trials.^4-9

Abbreviations:
HTN, hypertension; BP, blood pressure; ESC, European Society of Cardiology

References:
1. McEvoy JW, et al. Eur Heart J. 2025;46(14):1300; 2. Cohen JB. Hypertension. 2025;82(1):11-13.; 3. McCarthy CP, et al. Hypertension . 2025;82(3):432-444. 4. Pfeffer MA, et al. N Engl J Med 2003; 349(20): 1893-1906. 5. Cohn JN, et al. N Engl J Med 2001; 345(23): 1667-1675. 6. Viberti G et al. Circulation 2002; 106(6): 672-678. 7. Julius S et al. Lancet 2004; 363(9426): 2022-2031. 8. The NAVIGATOR study group. N Engl J Med 2010; 362: 1477-90. 9. Mancia G et al. J Hypertens. 2013; 31: 1281-357

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