New classification in 2024 ESC guidelines for management of elevated BP and hypertension

At the ESC Congress 2024, the 2024 ESC Guidelines for the Management of Elevated Blood Pressure and Hypertension were presented by John William Mcevoy and Felicita Andreotti  (Galway, Ireland and Rome, Italy).These new guidelines entail recommendations on diagnosis, risk assessment, prevention and management.

Highlights of the guidelines

• It is recommended to measure BP using a validated and calibrated device, to enforce the correct measurement technique, and to apply a consistent approach to BP measurement for each patient (class I, level B recommendation).
• There is an emphasis on out-of-office BP measurement for diagnosis and management (class I, level B recommendation).
• There is a new classification: non-elevated BP is defined as <120/70 mmHg, elevated BP by an office SBP 120-139 or CBP 70-89 mmHg and hypertension by office SBP≥140 mmHg or DBP ≥90 mmHg. There are accompanying out-of-office BP equivalents (HBPM or ABPM) defined.

• Risk assessment is recommended for adults with elevated BP to identify treatment plans.

• Lifestyle and pharmacological treatment is recommended for all individuals with hypertension and individuals with elevated BP, high CVD risk and BP 130-139/80-89 mmHg. In adults with elevated BP and high CVD risk, after 3 months of lifestyle intervention, BP lowering with pharmacological treatment is recommended for those with confirmed BP ≥130/80 mmHg. In hypertensive patients, irrespective of CVD risk, lifestyle and pharmacological treatment is initiated promptly.
• Start with low dose double combination therapy in patients with hypertension, then low-dose triple combination and then titrate doses up. In patients with elevated BP and increased CVD risk, consider initial monotherapy when SBP ≥130 mmHg.
• There are new lifestyle recommendations that include potassium supplementation (for patients with hypertension without moderate-to-advanced CKD and with high sodium intake), and restrictions in free sugar intake.
• There are new recommendations for managing specific patient groups. Renal denervation is recommended in selected patients and only in medium-high volume centers.
• The recommended SBP target is 120-129 mmHg in patients on BP-lowering medication. However, if this target is not possible, aim for BP that is as low as reasonable achievable (ALARA principle).

• There is a need for implementation of the guidelines – health care communities need to rise to the challenge.

- Our reporting is based on the information provided at the ESC Congress 2024 -

The guidelines are published in Eur Heart J