From the Guidelines
The latest European Society of Cardiology (ESC) guidelines on hypertension, as of 2024, define hypertension as an office systolic BP of ≥140 mmHg or diastolic BP of ≥90 mmHg, and introduce a new category called ‘Elevated BP’, defined as an office systolic BP of 120–139 mmHg or diastolic BP of 70–89 mmHg 1.
Key Recommendations
- The guidelines recommend pursuing a target systolic BP of 120–129 mmHg among adults receiving BP-lowering medications, with the caveat that treatment to this BP target should be well tolerated by the patient 1.
- The American College of Cardiology (ACC) and ESC guidelines have similarities and differences, with the ACC guidelines recommending antihypertensive drug therapy when SBP 130–139 mm Hg or DBP 80-89 mm Hg and CVD or 10-year atherosclerotic CVD risk ≥10%, whereas the ESC guidelines recommend drug therapy only be considered for SBP 130–139 mm Hg or DBP 85–89 mm Hg when CVD present, especially coronary heart disease 1.
Lifestyle Changes and Treatment
- Both guidelines emphasize the importance of accurate BP measurements and use of out-of-office readings, as well as lifestyle changes such as a low-sodium diet, exercise, body weight reduction, low to moderate alcohol intake, and adequate potassium intake 1.
- The guidelines also recommend antihypertensive drug therapy when SBP ≥140 mm Hg or DBP ≥90 mm Hg, with a similar core strategy for antihypertensive drug therapy and combination therapy for most adults with hypertension 1.
BP Targets and Treatment Approach
- The guidelines recommend lower BP targets compared with previous guidelines, with a personalized approach to definition of SBP targets and strategies to improve adherence and BP control 1.
- The ESC guidelines recommend a target systolic BP of <140/90 mmHg for all, with a more lenient approach for certain patient populations, such as those with symptomatic orthostatic hypotension, those aged 85 years or over, or those with moderate-to-severe frailty 1.
From the Research
Latest ESC/ACC Guidelines on Hypertension
The latest European Society of Cardiology (ESC) and American College of Cardiology (ACC) guidelines on hypertension emphasize the importance of accurate blood pressure measurement and lifestyle modifications as the primary intervention for the management of hypertension 2, 3.
Key Recommendations
- The use of home blood pressure monitoring or ambulatory monitoring is recommended for the primary prevention of hypertension 2.
- Non-pharmacological treatment, such as modifying one's lifestyle, is the primary intervention for the management of hypertension 2, 4.
- The ESC and ACC guidelines differ in their definition of high blood pressure and treatment goals, with the ACC suggesting a blood pressure of at least 130/80 mmHg and the ESC proposing a blood pressure of at least 140-159/90-99 mmHg 2.
- Combination therapies, such as single-pill treatments, are recommended to enhance adherence to medication and achieve blood pressure targets 2, 3.
Blood Pressure Targets
- The guidelines recommend individualized blood pressure targets based on comorbidities, hypertension-mediated organ damage, and cardiovascular risk factors 3.
- A blood pressure target of less than 120-140 mmHg systolic and 70-80 mmHg diastolic is recommended for most patients 3.
Lifestyle Management
- Lifestyle modifications, such as maintaining a healthy body weight, increasing physical activity, and healthy eating, are recommended as a first-line strategy to prevent and control hypertension 4.
- Avoidance and cessation of smoking and alcohol use, management of stress and sleep levels, and consumption of a healthy diet are also recommended 4.