Blood pressure standards have been tightened. The new values ​​may surprise even healthy people.

• The European Society of Cardiology has updated its blood pressure standards
• Experts have added a new category of blood pressure called "elevated blood pressure"
• They also remind us of the existence of two phenomena that can distort the diagnosis of hypertension: white coat hypertension and masked hypertension.

The European Society of Cardiology has presented new blood pressure guidelines. The comprehensive document states that the guidelines evaluate and summarize available evidence to help healthcare professionals recommend the best diagnostic or therapeutic approach for a specific patient with a given condition.

First and foremost, the new standards updated those issued in 2018 regarding the treatment of hypertension. It was noted that the new document updates and introduces new recommendations. The 2024 guidelines continue to define hypertension as an office systolic blood pressure of ≥140 mmHg or diastolic blood pressure of ≥90 mmHg.

It's worth noting, however, that a new category of blood pressure has been introduced called "elevated blood pressure." Elevated blood pressure is defined as:

• systolic blood pressure 120–139 mmHg or
• diastolic pressure 70–89 mmHg.

Another significant, evidence-based change in the 2024 guidelines is the recommendation to aim for a systolic blood pressure target of 120–129 mmHg in adults receiving blood pressure-lowering medications. As noted, there are several important caveats to this recommendation, including:

• the requirement that treatment to the target blood pressure be well tolerated by the patient,
• the fact that milder blood pressure targets may be considered in people with symptomatic orthostatic hypotension, people aged 85 years and older, or people with moderate or limited life expectancy,
• strong emphasis on out-of-office blood pressure measurement to confirm achievement of the target systolic pressure of 120–129 mmHg.

There are three categories of blood pressure classification:

• not elevated - < 120/70 mm Hg,
• elevated - 120-139/70-89 mm Hg,
• hypertension - ≥ 140/90 mm Hg.

Treatment of high blood pressure

At the same time, the ESC indicates that the higher the blood pressure, the higher the relative risk of cardiovascular disease, including atherosclerosis. The risk of adverse cardiovascular outcomes increases with persistent increases in systolic and diastolic blood pressure.

Simply using blood pressure thresholds for hypertension to allocate treatment would lead to undertreatment of many high-risk patients, we read.

If the blood pressure at the doctor's office is 120–139/70–89 mmHg, the patient is considered to have elevated blood pressure and further evaluation of the risk of cardiovascular disease is recommended to determine the therapy:

• In patients with elevated blood pressure who are not at increased risk of cardiovascular disease and do not have other high-risk medical conditions, lifestyle-based blood pressure lowering is recommended. If initial lifestyle measures are ineffective after 6–12 months, drug therapy may be discussed on an individual basis in adults at lower risk of cardiovascular disease when blood pressure is between 130/80 and <140/90 mmHg.
• In patients with elevated blood pressure (office blood pressure 120–139/70–89 mmHg) who are at sufficiently high risk of cardiovascular disease or in patients at high or borderline risk of cardiovascular disease, antihypertensive medications should be initiated for 3 months. Subsequently, pharmacological treatment is recommended for those with confirmed blood pressure ≥130/80 mmHg if lifestyle changes have not been effective or are not implemented. Emphasis should be placed on promptly adding pharmacological treatment, if necessary within 3 months, to avoid therapeutic inertia. In individuals with blood pressure 120–129/70–79 mmHg, sustained and intensive lifestyle intervention is preferred.

Experts also emphasize that home blood pressure measurements are crucial in diagnosing possible hypertension. They point out that measurements obtained in a doctor's office are not always reliable due to two factors:

• White coat hypertension – office blood pressure measurement was above 140/90 mmHg, while home blood pressure measurement was below 135/85 mmHg (or below 130/80 mmHg with 24-hour daytime monitoring). This is related to the fear of doctor visits among some patients;
• masked hypertension – the opposite situation, in which the blood pressure measured in the office is lower (below 140/90 mmHg), while measurements at home give higher results (above 135/85 mmHg or above 130/80 mmHg as part of 24-hour monitoring).

In the case of white coat hypertension, medications may be prescribed to a patient who does not require them at all, while in the case of masked hypertension there is a risk that drug treatment will be initiated too late.

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