Interpretation of 2024 ESC guidelines for the management of elevated blood pressure and hypertension_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHENG Yu ^1,2,3 , ZHOU Yiheng ^1,2,3 , LV Yao ^1,2,3 , LI Dongze ^4,5 , LIU Lidi ^1,2,3 , ZHANG Peng ^1,2,3 , YANG Rong ^1,2,3 , JIA Yu ^1,2,3 , ZENG Rui ⁶ , WAN Zhi ^4,5 ,  LIAO Xiaoyang ^1,2,3

1. General Practice Ward/ International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
2. Teaching & Research Section, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
3. General Practice Medical Center and General Practice Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
4. Emergency Department/Emergency Medicine Laboratory, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
5. Disaster Medicine Center, Sichuan University, Chengdu, 610041, P. R. China;
6. Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding author：

LIAO Xiaoyang, Email: 625880796@qq.com

Keywords：

The European Society of Cardiology (ESC); elevated blood pressure; hypertension; guidelines interpretation

DOI：

10.7507/1007-4848.202410039

Video：

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The European Society of Cardiology (ESC) released the "2024 ESC guidelines for the management of elevated blood pressure and hypertension" on August 30, 2024. This guideline updates the 2018 "Guidelines for the Management of Arterial Hypertension." One notable update is the introduction of the concept of "elevated blood pressure" (120-139/70-89 mm Hg). Additionally, a new systolic blood pressure target range of 120-129 mm Hg has been proposed for most patients receiving antihypertensive treatment. The guideline also includes numerous additions or revisions in areas such as non-pharmacological interventions and device-based treatments for hypertension. This article interprets the guideline's recommendations on definition and classification of elevated blood pressure and hypertension, and cardiovascular disease risk assessment, diagnosing hypertension and investigating underlying causes, preventing and treating elevated blood pressure and hypertension. We provide a comparison interpretation with the 2018 "Guidelines for the Management of Arterial Hypertension" and the "2017 ACC/AHA Guideline on the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults."

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2. Mills KT, Bundy JD, Kelly TN, et al. Global disparities of hypertension prevalence and control: A systematic analysis of population-based studies from 90 countries. Circulation, 2016, 134(6): 441-450.
3. 中国高血压防治指南修订委员会, 高血压联盟(中国), 中国医疗保健国际交流促进会高血压病学分会, 等. 中国高血压防治指南(2024年修订版). 中华高血压杂志(中英文), 2024, 32(7): 603-700.Chinese Hypertension Prevention and Treatment Guidelines Revision Committee, Hypertension Alliance (China), Hypertension Branch of China Association for International Exchange and Promotion of Healthcare, et al. Chinese guidelines for the prevention and treatment of hypertension (revised 2024 edition). Chin J Hypertens (both Chinese and English), 2024, 32(7): 603-700.
4. McEvoy JW, McCarthy CP, Bruno RM, et al. 2024 ESC guidelinesfor the management of elevated blood pressure and hypertension. Eur Heart J, 2024, 45(38): 3912-4018.
5. Williams B, Mancia G, Spiering W, et al. 2018 practice guidelinesfor the management of arterial hypertension of the EuropeanSociety of Hypertension and the European Society of Cardiology: ESH/ESC Task Force for the Management of Arterial Hypertension. J Hypertens, 2018, 36(12): 2284.-2309.
6. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: Executive summary: A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation, 2018, 138(17): e426-e483.
7. Herrett E, Strongman H, Gadd S, et al. The importance of blood pressure thresholds versus predicted cardiovascular risk on subsequent rates of cardiovascular disease: A cohort study in English primary care. Lancet Healthy Longev, 2022, 3(1): e22-e30.
8. Karmali KN, Ning H, Goff DC, et al. Identifying individuals at risk for cardiovascular events across the spectrum of blood pressure levels. J Am Heart Assoc, 2015, 4(9): e002126.
9. Blood Pressure Lowering Treatment Trialists' Collaboration. Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: An individual participant-level data meta-analysis. Lancet, 2021, 397(10285): 1625-1636.
10. Brunström M, Carlberg B. Association of blood pressure lowering with mortality and cardiovascular disease across blood pressure levels: A systematic review and meta-analysis. JAMA Intern Med, 2018, 178(1): 28-36.
11. Ettehad D, Emdin CA, Kiran A, et al. Blood pressure lowering for prevention of cardiovascular disease and death: A systematic review and meta-analysis. Lancet, 2016, 387(10022): 957-967.
12. Sundström J, Arima H, Jackson R, et al. Effects of blood pressure reduction in mild hypertension: A systematic review and meta-analysis. Ann Intern Med, 2015, 162(3): 184-191.
13. Arguedas JA, Leiva V, Wright JM. Blood pressure targets in adults with hypertension. Cochrane Database Syst Rev, 2020, 12(12): CD004349.
14. Wright JT, Williamson JD, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med, 2015, 373(22): 2103-2116.
15. Zhang W, Zhang S, Deng Y, et al. Trial of intensive blood-pressure control in older patients with hypertension. N Engl J Med, 2021, 385(14): 1268-1279.
16. Forouzanfar MH, Liu P, Roth GA, et al. Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990-2015. JAMA, 2017, 317(2): 165-182.
17. Whelton SP, McEvoy JW, Shaw L, et al. Association of normal systolic blood pressure level with cardiovascular disease in the absence of risk factors. JAMA Cardiol, 2020, 5(9): 1011-1018.
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Latest ArticlesInterpretation of 2024 ESC guidelines for the management of elevated blood pressure and hypertension

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