The European Society of Cardiology (ESC) has released updated guidelines for managing elevated blood pressure and hypertension, marking significant changes in how these conditions are treated.
These guidelines, published in the European Heart Journal, include the introduction of a new category for elevated blood pressure, more ambitious treatment targets, and new recommendations on the use of renal denervation—a medical procedure for treating certain forms of hypertension.
The guidelines were developed by an international panel of experts, including co-Chairpersons Professor Bill McEvoy from the University of Galway, Ireland, and Professor Rhian Touyz from McGill University, Canada.
Hypertension, or high blood pressure, remains the leading risk factor for heart attacks and strokes worldwide. In Europe, approximately 45% of adults suffer from hypertension, making effective management crucial.
The updated ESC guidelines aim to ensure that more patients reach optimal blood pressure levels based on the latest evidence from clinical trials, while also avoiding the risks of overtreatment.
One of the most notable updates in the 2024 guidelines is the introduction of a new “elevated blood pressure” category, defined as a systolic blood pressure (BP) of 120-139 mmHg and diastolic BP of 70-89 mmHg.
This category is meant to recognize that blood pressure often increases gradually rather than suddenly, and that early intervention may benefit individuals at higher risk for cardiovascular disease, such as those with diabetes.
The guidelines maintain the existing definition of hypertension as BP ≥140/90 mmHg but advocate for more intensive treatment targets.
Specifically, the new guidelines recommend a systolic BP target range of 120-129 mmHg for most patients on blood pressure-lowering medications.
This represents a shift from previous guidelines, which generally advised lowering BP to less than 140/90 mmHg initially and then considering a further reduction to less than 130/80 mmHg.
The new approach suggests starting with a more intensive target from the outset, provided that the patient can tolerate the treatment.
Professor McEvoy highlighted that this change is driven by recent trial evidence showing that more intensive blood pressure management significantly reduces the risk of cardiovascular disease across a broad range of patients.
However, for frail or older patients, or those who cannot tolerate the lower BP target, the guidelines recommend adjusting the target to what is “as low as reasonably achievable” (ALARA), emphasizing the importance of individualizing treatment based on a patient’s overall health and tolerance.
The 2024 guidelines also place a stronger emphasis on the use of out-of-office blood pressure measurements, such as ambulatory and home BP monitoring.
These methods are recommended to ensure accurate BP readings and to help achieve the new, more stringent treatment targets.
For the first time, the guidelines address the use of renal denervation, a procedure that involves using a catheter to disrupt nerve signals in the kidneys, which can help lower blood pressure.
However, the guidelines caution that this procedure should not be the first-line treatment for hypertension and should be considered only in specific cases.
Renal denervation may be an option for patients with resistant hypertension—those whose blood pressure remains uncontrolled despite taking three different BP-lowering drugs, including a diuretic.
Even in these cases, the procedure should only be performed in specialized centers with experience in the technique, and only after a thorough discussion of the risks and benefits with the patient.
In addition to these changes, the guidelines update recommendations on dietary sodium and potassium intake, reinforce the importance of lifestyle modifications, and emphasize the consideration of sex and gender differences in hypertension management.
These aspects are integrated throughout the document rather than being treated as separate topics, reflecting a more holistic approach to hypertension management.
In summary, the 2024 ESC guidelines represent a significant shift towards more aggressive and personalized management of hypertension, with the goal of better preventing heart attacks, strokes, and other cardiovascular diseases.
The introduction of new treatment targets, along with the cautious recommendation of renal denervation, underscores the evolving understanding of how best to manage high blood pressure in different patient populations.
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The research findings can be found in the European Heart Journal.
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