[Elevated blood pressure and hypertension : Focus of the 2024 ESC guidelines on risk reduction].

Abstract

The 2024 guidelines of the European Society of Cardiology (ESC) for the management of elevated blood pressure and hypertension introduce the new category "elevated blood pressure" (120-139/70-89 mm Hg). All patients with elevated blood pressure are advised to implement lifestyle modifications. The aim is to reduce the cardiovascular risk at an early stage. In addition, a structured assessment should be carried out based on the comorbidities, such as coronary artery disease, heart failure and stroke as well as on risk factors, which can result from an antihypertensive treatment in cases of moderate to high risk and a blood pressure of 130/80 mm Hg or more despite 3 months of lifestyle modifications. For patients with hypertension (≥ 140/90 mm Hg), the guidelines now recommend initiating lifestyle modifications and antihypertensive medication concurrently. The new target systolic blood pressure is 120-129 mm Hg, with establishment of individualized treatment goals in cases of frailty or age ≥85 years. Compared to the guidelines of the European Society of Hypertension (ESH) and the German national guidelines (NVL), the ESC extends the treatment recommendations to patients with elevated blood pressure even below the threshold of 140/90 mm Hg. For resistant hypertension spironolactone is recommended, with renal denervation being an alternative option to increasing the antihypertensive medication.