3 Sept 2024 • Simplified and more aggressive targets are among the significant changes to the updated hypertension guidelines released by the European Society of Cardiology.

• A new BP category termed ‘elevated BP’ has been introduced – defined as an office systolic BP 120–139 mmHg or diastolic BP 70–89 mmHg – while hypertension remains as defined previously (office systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg).
• A new major, evidence-based change is the recommendation to pursue a target systolic BP of 120–129 mmHg among adults receiving BP-lowering medications.
• This new systolic BP treatment target of 120–129 mmHg represents a paradigm shift from prior European guidelines. Specifically, whereas prior guidelines generally recommended patients be treated to <140/90 mmHg in the first instance and only thereafter be considered for treatment to <130/80 mmHg (a two-step approach), the new guidelines recommend that most patients should be treated to 120–129 mmHg in the first instance, with a more relaxed target in those where it cannot be tolerated.
• The guidelines also introduce new recommendations for lifestyle options to help lower BP, including changes to exercise advice and the addition of potassium supplementation. And for the first time, the ESC guidelines provide recommendations for the use of renal denervation to treat hypertension in certain circumstances.
• For persons with elevated BP, treatment with lifestyle for 3 months is first recommended, prior to considering medications. After 3 months of lifestyle intervention, in adults with elevated BP and sufficiently high CVD risk (≥10% over 10 years), BP lowering with pharmacological treatment is recommended for those with confirmed BP ≥130/80 mmHg to reduce CVD risk.
• With increasing evidence that biological sex and sociocultural gender are modifiers of hypertension, the 2024 guidelines have included ‘sex and gender’ as an integral component throughout the document.

Source: ESC 2024 | Read full story