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[Management of elevated blood pressure and hypertension : Focus on risk reduction]

Raphael S Schmieder1, Heribert Schunkert2,3

  • 1Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München (DHM), Universitätsklinikum der Technischen Universität München, München, Deutschland. schmieder@dhm.mhn.de.

Herz
|July 24, 2026
PubMed

Insights

The 2024 European Society of Cardiology (ESC) guidelines introduce

Area of Science:

  • Cardiology and Hypertension Management

Background:

  • Blood pressure is a continuous cardiovascular risk factor.
  • New guidelines emphasize early prevention for elevated blood pressure.
  • Comorbid conditions necessitate tailored hypertension management.

Purpose of the Study:

  • To outline the 2024 European Society of Cardiology (ESC) hypertension guidelines.
  • To define management strategies for elevated blood pressure and hypertension.
  • To highlight treatment targets and options for resistant hypertension.

Main Methods:

  • Introduction of 'elevated blood pressure' category (120-139/70-89 mmHg).
  • Emphasis on lifestyle modifications for all affected individuals.
  • Pharmacotherapy recommendations based on blood pressure levels and cardiovascular risk.

Main Results:

  • Antihypertensive treatment may be initiated below the traditional hypertensive range.
  • Pharmacotherapy advised if blood pressure remains >130/80 mmHg with comorbidities or high risk.
  • Concurrent lifestyle measures and dual therapy recommended at ≥140/90 mmHg.

Conclusions:

  • Target systolic blood pressure is 120-129 mmHg, with exceptions for frail or elderly patients.
  • Spironolactone is recommended for resistant hypertension.
  • Renal denervation is an interventional option for resistant hypertension.

Keywords:
Blood pressure targetCardiovascular risk assessmentGuidelineHolistic approachHypertension

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