Applying the 2024 European Society of Cardiology Guidelines for the management of elevated blood pressure and hypertension to a Norwegian general population cohort from age 40: data from the Akershus Cardiac Examination 1950 study.

Background: The 2024 European Society of Cardiology (ESC) Guidelines for hypertension introduced the 'elevated BP' (eBP) category (120-139/70-89 mm Hg). Individuals with persistent eBP (130-139/80-89 mm Hg), despite lifestyle intervention, may be recommended pharmacological treatment in case of concomitant elevated cardiovascular (CV) risk. We aimed to assess the impact of these updated recommendations on treatment eligibility at ages 40 and 62-65 and to examine the CV event rates over 30 years of follow-up, focusing on those with eBP (130-139/80-89 mm Hg) eligible for pharmacological treatment.

Methods: Data from individuals born in 1950 who participated in the Age 40 Programme and the Akershus Cardiac Examination 1950 Study was linked to national health registries. These data include BP measurements at age 40 (1990-1991) and 62-65 (2012-2015), assessment of elevated CV risk based on Systematic Coronary Risk Evaluation 2 (SCORE2) and outcomes of major adverse cardiovascular events (MACEs) tracked through 2022.

Results: At age 40, 854 (32%) of 2688 individuals had eBP (130-139/80-89 mm Hg), but only 4 had elevated CV risk warranting pharmacological treatment. At age 62-65, 1657 (61%) were on BP-lowering medication or had a BP ≥140/90, while 64 (8%) out of 851 with eBP were eligible for drug treatment. Based on BP values at age 40, only 2 of the 93 MACEs in the eBP (130-139/80-89 mm Hg) category occurred among those eligible for pharmacological treatment.

Conclusions: A single BP measurement at age 40 identified eBP (130-139/80-89 mm Hg) among one-third of the individuals, yet MACE cases within the eBP category occurred primarily in individuals who were not eligible for medical treatment.