Reclassification of patients with normal blood pressure levels after 2024 European society of cardiology guidelines on hypertension.

Introduction: In 2024, the European Society of Cardiology (ESC) guidelines proposed a new classification of elevated blood pressure (BP) and hypertension.

Aim: To evaluate how many individuals with optimal, normal, and high-normal BP, as defined by the 2023 European Society of Hypertension (ESH) guidelines, would be reclassified as not-elevated or elevated BP, according to the new ESC guidelines.

Methods: In this single-center, observational, retrospective, cohort study, we included adult individuals who were consecutively evaluated for home, office, and ambulatory BP measurements, and global cardiovascular risk stratification. All patients underwent BP measurements using a validated, oscillometric, automatic device (Mobil-O-Graph PWA Monitor, I.E.M. GmbH, Stolberg, Germany). Only untreated individuals with office BP levels <140/<90  mmHg and without comorbidities were considered for the analysis. Selected population was stratified according to 2023 ESH (optimal BP, <120/<80  mmHg; normal BP, 120-129/80-84 mmHg; high-normal BP, 130-139/85-89  mmHg) and then reclassified according to 2024 ESC guidelines (not-elevated BP, <120/<70  mmHg; elevated BP, 120-139/70-89 mmHg). Home and 24-h ambulatory BP levels were also evaluated in each category, when available.

Results: We analysed 1230 adult untreated individuals with valid office BP levels, among whom 89.0% also had ambulatory and 42.6% home BP data, respectively. According to 2023 ESH guidelines, 262 (21.3%) individuals had optimal, 375 (30.5%) normal, and 593 (48.2%) high-normal BP levels; according to 2024 ESC guidelines, 87 (7.1%) had nonelevated, and 1143 (92.9%) had elevated BP. Compared to 2023 ESH guidelines, 66.8% individuals with optimal BP, and all individuals (100.0%) with normal and high-normal BP levels were reclassified as elevated BP by adopting 2024 ESC guidelines. This shift is more evident in women than in men (67.2 vs. 65.8%; P < 0.001).

Conclusion: According to 2024 ESC guidelines, most individuals with optimal, and all those with normal and high-normal BP levels, as defined by 2023 ESH guidelines, are reclassified in the elevated BP category.