The European Society of Cardiology (ESC) recently released updated guidelines on the management of elevated blood pressure and hypertension to better identify people at risk of heart attack and stroke.
The new guidelines include a new category of Elevated Blood Pressure, more ambitious and intensive treatment targets, and, for the first time, recommendations on the use of renal denervation to treat various forms of hypertension.
The guidelines have been produced by an international panel of experts, including co-chairpersons, Professor Bill McEvoy of University of Galway, and Professor Rhian Touyz of McGill University, Canada.
This is the first time that an Irish academic has led a major European clinical practice guideline on the treatment of elevated blood pressure and hypertension, which has potential implications for more than 700 million Europeans.
Prof McEvoy is also first author on the principal results paper for the INTERASPIRE research study which is being published in the European Heart Journal and coincides with the ESC Congress on Friday 30 August, the world’s largest gathering of cardiovascular professionals.
In the INTERASPIRE global study, 61 per cent of participants with heart disease did not have their blood pressure controlled.
Key takeaways from the updated ESC guidelines on hypertension:
- A new systolic blood pressure (BP) treatment target range of 120-129 mmHg for most patients receiving BP lowering medication.
By placing the emphasis on an intensive treatment target as the first step in managing most patients, and only opting out of this target in select circumstances or when treatment is not tolerated by the patient, these 2024 guidelines represent a paradigm shift from previous European guidelines.
- The definition of hypertension remains BP ?140/90 mmHg, however, the guidelines introduce a new category of ‘Elevated Blood Pressure’ which is defined as a BP 120-139/70-89 mmHg.
- The new ‘Elevated Blood Pressure’ category is introduced to facilitate consideration of more intensive blood pressure treatment targets among people at increased risk for cardiovascular disease.
- The updated guidelines introduce recommendations for new lifestyle options to help lower BP, such as new guidance on exercise and potassium supplementation.
- For the first time the ESC Hypertension Guidelines provide recommendations of the use of renal denervation to treat hypertension.
The new 2024 ESC Guidelines are designed to get more patients to an evidence-based blood pressure treatment target and to increase the eligibility for blood pressure lowering medications to match the best current evidence from clinical trials.
They also provide numerous pragmatic recommendations to avoid patients becoming symptomatic from overtreatment.
Prof McEvoy, Professor of Preventive Cardiology at University of Galway and Medical and Research Director of NIPC, said:“The new category of Elevated Blood Pressure recognises that people do not go from normal BP to hypertensive overnight.
“It is in most cases a steady gradient of change, and different subgroups of patients – for example those at a higher risk of developing cardiovascular disease such as people living with diabetes – could benefit from more intensive treatment before their blood pressure reaches the traditional threshold of hypertension.”
