What It Means and Key Highlights of 2024 European Hypertension Guidelines?

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What It Means and Key Highlights of 2024 European Hypertension Guidelines?

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Blood Pressure Above 120/70 mmHg: What It Means and Key Highlights of 2024 European Hypertension Guidelines?

The 2024 European Society of Cardiology (ESC) Congress is currently taking place in London, UK.

As one of Europe’s largest cardiovascular conferences, it brings together numerous global medical institutions and experts, showcasing significant advancements in cardiovascular research.

The “2024 European Society of Cardiology Blood Pressure and Hypertension Management Guidelines,” developed by the ESC’s hypertension management working group and in collaboration with the European Society of Endocrinology (ESE) and the European Stroke Organisation (ESO), have been officially released at the ESC Congress and published in the European Heart Journal.

This update builds upon the 2018 ESC/European Society of Hypertension (ESH) hypertension management guidelines.

Here are the essential points from the new guidelines:

Key Updates in the 2024 Guidelines

1. Revised Blood Pressure Targets: For most patients undergoing antihypertensive treatment, the target systolic blood pressure has been revised to 120-129 mmHg. The focus is on achieving this target unless it is not tolerated or in specific situations where this target may be adjusted. This marks a shift in the guideline paradigm.

2. Practical Blood Pressure Reduction Recommendations: For patients who cannot tolerate or achieve the intensified blood pressure targets, the guidelines now recommend lowering blood pressure to the lowest reasonable and achievable level.

3. Introduction of the “Elevated Blood Pressure” Category: The definition of hypertension remains at ≥140/90 mmHg, but the concept of “elevated blood pressure” (120-139/70-89 mmHg) has been introduced. This is expected to facilitate more intensive treatment in patients at higher risk of cardiovascular events and strokes.

4. New Lifestyle Recommendations: The guidelines now include new lifestyle interventions to aid in blood pressure management, such as updated exercise recommendations and potassium supplementation.

5. Renal Denervation: For the first time, the guidelines provide specific recommendations for using renal denervation to treat hypertension.

Key Recommendations on Prevention and Drug Treatment

• Screening for Children and Adolescents: For children and adolescents, particularly those with a family history of hypertension, opportunistic screening and monitoring of blood pressure changes are recommended to better predict the risk of developing hypertension and related cardiovascular diseases in adulthood.

• Sugar Intake Limitation: It is advised to limit free sugar intake, especially from sugary beverages, to no more than 10% of total caloric intake. It is also recommended to avoid sugary drinks like soft drinks and fruit juices in youth.

• Potassium Intake: For patients with high daily sodium intake but no chronic kidney disease, replacing regular salt with a potassium-enriched low-sodium salt and increasing potassium intake through fruits and vegetables is suggested.

• Monitoring in CKD Patients: For patients with chronic kidney disease or those on potassium-sparing medications, monitoring serum potassium levels is recommended if dietary potassium intake increases.

• Medication Adherence: Patients are encouraged to take medications at their most convenient time and establish a regular medication routine to improve adherence.

• Lifestyle Changes for Elevated Blood Pressure: Adults with elevated blood pressure and low/moderate cardiovascular risk should focus on lifestyle changes to lower both blood pressure and cardiovascular risk.

• Drug Treatment for High Risk: For adults with elevated blood pressure and significant cardiovascular risk, medication is recommended if blood pressure remains ≥130/80 mmHg after 3 months of lifestyle changes.

• Immediate Treatment for Hypertension: For those diagnosed with ≥140/90 mmHg, lifestyle changes and medication should begin immediately, regardless of cardiovascular risk.

• Long-term Treatment: Lifelong antihypertensive therapy is advised for patients with good tolerance, potentially extending beyond age 85.

• Monitoring and Adjusting Treatment: For patients with poor tolerance or whose blood pressure remains high despite treatment, adjusting targets to the lowest reasonable level and regular monitoring is suggested.

Renal Denervation Specifics

Renal denervation, which interrupts sympathetic nerve activity in the renal arteries and surrounding tissues, has shown potential benefits in reducing blood pressure. Although promising, the procedure is currently recommended only under specific conditions due to unresolved issues.

• Consideration for Resistant Hypertension: For patients with resistant hypertension not controlled by a combination of three antihypertensive drugs, renal denervation may be considered if performed at large medical centers with patient consent and multidisciplinary evaluation.

• Increased Cardiovascular Risk: For patients with elevated cardiovascular risk who have not controlled their blood pressure with fewer than three medications, renal denervation may be considered under similar conditions.

• Not a First-Line Treatment: Due to insufficient evidence of its efficacy and safety, renal denervation is not recommended as a first-line treatment for hypertension.

• Caution in Severe Renal Impairment: The use of renal denervation is not recommended for patients with moderate to severe renal impairment (eGFR <40 ml/min/1.73 m²) or persistent hypertension until further evidence is available.

Blood Pressure Above 120/70 mmHg: What It Means and Key Highlights of 2024 European Hypertension Guidelines?

Reference:

[1] John William McEvoy, Cian P McCarthy, Rosa Maria Bruno, et al.2024 ESC Guidelines for the management of elevated blood pressure and hypertension: Developed by the task force on the management of elevated blood pressure and hypertension of the European Society of Cardiology (ESC) andendorsed by the European Society of Endocrinology (ESE) and the European Stroke Organisation (ESO), European Heart Journal, 2024;, ehae178 

(source:internet, reference only)

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Important Note: The information provided is for informational purposes only and should not be considered as medical advice.