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Cardiovascular Risk Across Blood Pressure Categories Defined by the 2024 ESC and 2023 ESH Hypertension Guidelines:

Dae Young Cheon1, Kyung-do Han2, Yeon Jung Lee1

  • 1Division of Cardiology, Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hwaseong, Korea.

European Journal of Preventive Cardiology
|September 3, 2025
PubMed

Insights

The 2024 European Society of Cardiology (ESC) guidelines for elevated blood pressure (BP) and hypertension identify a broader population at increased cardiovascular disease risk. Elevated BP, as per ESC, is linked to a modestly higher risk of events like ischemic stroke.

Area of Science:

  • Cardiology
  • Public Health
  • Epidemiology

Background:

  • The European Society of Cardiology (ESC) updated blood pressure (BP) categorization in 2024 into non-elevated BP, elevated BP, and hypertension.
  • Assessing the predictive value of these new ESC guidelines for future cardiovascular disease (CVD) risk is crucial.

Purpose of the Study:

  • To evaluate if the 2024 ESC guidelines for elevated BP and hypertension accurately identify individuals at higher risk of future cardiovascular diseases.
  • To compare risk stratification using the 2024 ESC guidelines versus the 2023 European Society of Hypertension (ESH) classification.

Main Methods:

  • A population-based cohort study utilized data from the Korean National Health Insurance Service database (2009).
  • Included were individuals aged ≥40 years without prior stroke or myocardial infarction, followed for a mean of 11.66 years.
  • Multivariable Cox proportional hazards models assessed the association between BP categories and composite outcomes (stroke, myocardial infarction, all-cause mortality).

Main Results:

  • The study analyzed 2,604,340 participants.
  • Both elevated BP and hypertension groups, per ESC 2024, showed significantly higher risks for composite outcomes (aHR 1.072 and 1.201, respectively) compared to non-elevated BP.
  • Risks for stroke, myocardial infarction, and all-cause mortality were significantly elevated in both the elevated BP and hypertension groups.

Conclusions:

  • The 2024 ESC guidelines for elevated BP and hypertension are associated with an increased risk of future cardiovascular events.
  • The ESC framework identified a broader at-risk population compared to the 2023 ESH classification.
  • Individuals with elevated BP, as defined by ESC 2024, exhibit a modestly higher risk of cardiovascular events, particularly ischemic stroke.
Abstract

Keywords:
Blood pressureCardiovascular DiseasesHypertension

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