From the Guidelines
The 2024 European Society of Cardiology (ESC) hypertension guidelines recommend upfront low-dose combination therapy as the preferred treatment approach for adults with confirmed hypertension, with a target blood pressure of 120–129/70–79 mmHg, if treatment is well tolerated. The guidelines emphasize the importance of earlier intervention and simplified treatment strategies to improve adherence and outcomes. Key recommendations include:
- Using single-pill combinations of two major drug classes, such as a renin-angiotensin system blocker (ACE inhibitor or ARB) with either a calcium channel blocker or diuretic, as first-line treatment for most patients 1.
- Pursuing a target systolic BP of 120–129 mmHg among adults receiving BP-lowering medications, with caveats for symptomatic orthostatic hypotension, those aged 85 years or over, or those with moderate-to-severe frailty 1.
- Considering device-based interventions like renal denervation after optimizing medication for resistant hypertension.
- Emphasizing cardiovascular risk assessment using the SCORE2 system and addressing hypertension emergencies with specific medication recommendations. These changes reflect a more aggressive approach to blood pressure management, prioritizing earlier intervention and simplified treatment strategies to improve adherence and outcomes, as supported by the most recent evidence 1. The guidelines also introduce a new BP category called ‘Elevated BP’, defined as an office systolic BP of 120–139 mmHg or diastolic BP of 70–89 mmHg, and recommend BP-lowering medications for persons with high CVD risk and BP levels that are elevated but do not meet traditional thresholds used to define hypertension 1. Overall, the 2024 ESC guidelines prioritize a patient-centered approach, emphasizing the importance of individualized treatment and lifestyle modifications to improve blood pressure control and reduce cardiovascular risk, as evidenced by the latest research 1.
From the Research
New Recommendations in the 2024 ESC Hypertension Guidelines
The 2024 European Society of Cardiology (ESC) guidelines for the management of elevated blood pressure and hypertension introduce several new recommendations, including:
- A new blood pressure categorization:
- Nonelevated (office BP <120/70 mm Hg) for which drug treatment is not recommended 2
- Elevated (120-139/70-89 mm Hg) for which drug treatment is recommended based on cardiovascular disease risk and follow-up BP level 2, 3
- Hypertension (≥140/90 mm Hg) for which prompt confirmation and drug treatment are recommended in most individuals 2, 3
- Initial default systolic BP treatment target of 120 to 129 mm Hg, with relaxed targets (BP as low as reasonably achievable) recommended in certain cases, such as treatment intolerance, adults ≥85 years, symptomatic orthostasis, moderate-to-severe frailty, or limited life expectancy 2, 3
- Recommendation for all patients with elevated blood pressure to implement lifestyle modifications, with a structured assessment based on comorbidities and risk factors 3
- Initiation of lifestyle modifications and antihypertensive medication concurrently for patients with hypertension (≥ 140/90 mm Hg) 3
- Recommendation for spironolactone for resistant hypertension, with renal denervation as an alternative option to increasing antihypertensive medication 3
Key Aspects of the New Guidelines
The new guidelines extend treatment recommendations to patients with elevated blood pressure even below the threshold of 140/90 mm Hg, compared to previous guidelines from the European Society of Hypertension (ESH) and the German national guidelines (NVL) 3. The guidelines also emphasize the importance of individualized treatment goals, particularly in cases of frailty or age ≥85 years 2, 3.