The ‘ten commandments’ for the 2024 European Society of Cardiology guidelines on elevated blood pressure and hypertension (2024)

Article Navigation

Volume 45 Issue 44 21 November 2024

Article Contents

  • Declarations

  • Reference

  • < Previous
  • Next >

Journal Article

,

Cian P McCarthy

Division of Cardiology, Massachusetts General Hospital and Harvard Medical School

,

Boston, MA

,

USA

Search for other works by this author on:

Oxford Academic

,

Rhian M Touyz

Department of Medicine, McGill University

,

1001 Decarie Boulevard, Montreal, Quebec H4A 3J1

,

Canada

Research Institute of the McGill University Health Centre, McGill University

,

2155 Guy Street, Montreal, Quebec H3H 2R9

,

Canada

Corresponding authors. Email: Johnwilliam.mcevoy@universityofgalway.ie (J.W.M.); Email: rhian.touyz@mcgill.ca (R.M.T.)

Search for other works by this author on:

Oxford Academic

John W McEvoy

Cardiology Department, Galway University Hospital and University of Galway School of Medicine

,

Newcastle Road, Galway H91 YR71

,

Ireland

Johns Hopkins Ciccarone Centre for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine

,

601 North Caroline Street, Baltimore, MD 21287

,

USA

Corresponding authors. Email: Johnwilliam.mcevoy@universityofgalway.ie (J.W.M.); Email: rhian.touyz@mcgill.ca (R.M.T.)

Search for other works by this author on:

Oxford Academic

European Heart Journal, Volume 45, Issue 44, 21 November 2024, Pages 4682–4683, https://doi.org/10.1093/eurheartj/ehae646

Published:

16 October 2024

  • PDF
  • Split View
  • Views
    • Article contents
    • Figures & tables
    • Video
    • Audio
    • Supplementary Data
  • Cite

    Cite

    Cian P McCarthy, Rhian M Touyz, John W McEvoy, The ‘ten commandments’ for the 2024 European Society of Cardiology guidelines on elevated blood pressure and hypertension, European Heart Journal, Volume 45, Issue 44, 21 November 2024, Pages 4682–4683, https://doi.org/10.1093/eurheartj/ehae646

    Close

Search

Close

Search

Advanced Search

Search Menu

The 2024 European Society of Cardiology (ESC) guidelines for the management of elevated blood pressure (BP) and hypertension were developed by a multidisciplinary team including patient representatives.1 These ‘ten commandments’ summarize the guideline (Figure 1).

  1. Blood pressure classification: A new BP classification is introduced: non-elevated (office BP < 120/70 mmHg), elevated BP (office BP 120–139/70–89 mmHg), and hypertension (office BP ≥ 140/90 mmHg).

  2. Diagnosis: Out-of-office BP measurement is recommended for the diagnosis and management of elevated BP and hypertension when logistically and economically feasible (preferred over office BP).

  3. Risk assessment: Risk assessment is recommended for persons with elevated BP to identify high cardiovascular disease (CVD) risk individuals. Risk assessment follows a step-wise approach: (i) assess for high CVD risk conditions (e.g. established CVD), (ii) predict 10-year risk of CVD, (iii) evaluate for sex-specific and shared risk modifiers, and (iv) consider additional testing with risk tools.

  4. Elevated BP with low CVD risk: Lifestyle measures are recommended for elevated BP and low CVD risk (no high CVD risk conditions and 10-year predicted CVD risk < 5% or borderline risk of 5–<10% without risk modifiers or abnormal risk tests).

  5. Elevated BP with high CVD risk: For elevated BP and high CVD risk (high risk CVD conditions or 10-year risk ≥ 10% or borderline risk of 5–<10% with risk modifiers or abnormal risk tests), lifestyle measures are recommended initially and after 3 months, if BP remains ≥ 130/80 mmHg, pharmacological BP-lowering treatment is recommended.

  6. Hypertension: Lifestyle and pharmacological BP-lowering treatment are recommended for hypertension. Single-pill double combination treatment is recommended initially for most patients.

  7. Lifestyle management: Updated lifestyle recommendations include aerobic and resistance training, increasing potassium intake, reducing sodium intake (<2 g/day), healthy diet, maintain normal body-mass index, smoking cessation, and limiting alcohol intake.

  8. Blood pressure target: For patients on treatment, a systolic BP target of 120–129 mmHg [including for non-frail older individuals (<85 years)] is recommended. If not possible/tolerated—or in persons ≥ 85 years or with symptomatic orthostasis, moderate-to-severe frailty, or limited lifespan—target a BP that is as low as reasonably achievable (ALARA).

  9. Resistant hypertension: For resistant hypertension, spironolactone (eplerenone if not tolerated), followed by beta blockers and subsequently, additional medications (e.g. alpha blockers) should be considered. Renal denervation may also be considered.

  10. Multidisciplinary team: Multidisciplinary approaches are strongly recommended to improve BP control, including task-shifting away from physicians.

The ‘ten commandments’ for the 2024 European Society of Cardiology guidelines on elevated blood pressure and hypertension (4)

Figure 1

Summarizing the ‘ten commandments’ of the 2024 ESC Clinical Practice Guidelines for the Management of Elevated Blood Pressure and Hypertension. N.B., for the 5th commandment, drug treatment is only for persons with high CVD risk and a repeat confirmed BP of 130/80 mmHg or more after 3 months of lifestyle measures. N.B., For the 5th commandment, drug treatment is only for persons with high CVD risk and a repeat confirmed BP of 130/80 mmHg or more after 3 months of lifestyle measures. ALARA, as low as reasonably achievable; CVD, cardiovascular disease; SBP, systolic blood pressure

Open in new tabDownload slide

Declarations

Disclosure of Interest

C.P.M. is supported by a National Heart, Lung, and Blood Institute Career Development Award (K23HL167659) and has received consulting fees/honorarium from Roche Diagnostic, Abbott Laboratories, New Amsterdam Pharma, and HeartFlow, Inc. The remaining authors have nothing to disclose.

Reference

1

McEvoy

JW

,

McCarthy

CP

,

Bruno

RM

,

Brouwers

S

,

Canavan

MD

,

Ceconi

C

, et al.

2024 ESC Guidelines for the management of elevated blood pressure and hypertension

.

Eur Heart J

2024

;

45

:

3912

4018

.

Published by Oxford University Press on behalf of the European Society of Cardiology 2024.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights)

Issue Section:

CardioPulse

Download all slides

Advertisement intended for healthcare professionals

Citations

Views

4,329

Altmetric

More metrics information

Metrics

Total Views 4,329

3,223 Pageviews

1,106 PDF Downloads

Since 10/1/2024

Month: Total Views:
October 2024 2,176
November 2024 2,153

Citations

Powered by Dimensions

Altmetrics

×

Email alerts

Article activity alert

Advance article alerts

New issue alert

Receive exclusive offers and updates from Oxford Academic

Citing articles via

Google Scholar

  • Latest

  • Most Read

  • Most Cited

Ablation of persistent atrial fibrillation: lessons learnt from the CAPLA trial
Enhanced Parkin-mediated mitophagy mitigates adverse left ventricular remodelling after myocardial infarction: role of PR-364
Percutaneous vs. surgical revascularization of non-ST-segment elevation myocardial infarction with multivessel disease: the SWEDEHEART registry
Accelerated atrial pacing reduces left-heart filling pressure: a combined clinical-computational study
Accelerated pacing as a treatment for heart failure with preserved ejection fraction and atrial fibrillation?

More from Oxford Academic

Cardiovascular Medicine

Clinical Medicine

Medicine and Health

Books

Journals

Advertisement intended for healthcare professionals

The ‘ten commandments’ for the 2024 European Society of Cardiology guidelines on elevated blood pressure and hypertension (2024)
Top Articles
Latest Posts
Recommended Articles
Article information

Author: Jamar Nader

Last Updated:

Views: 6640

Rating: 4.4 / 5 (75 voted)

Reviews: 90% of readers found this page helpful

Author information

Name: Jamar Nader

Birthday: 1995-02-28

Address: Apt. 536 6162 Reichel Greens, Port Zackaryside, CT 22682-9804

Phone: +9958384818317

Job: IT Representative

Hobby: Scrapbooking, Hiking, Hunting, Kite flying, Blacksmithing, Video gaming, Foraging

Introduction: My name is Jamar Nader, I am a fine, shiny, colorful, bright, nice, perfect, curious person who loves writing and wants to share my knowledge and understanding with you.