Guidelines for the management of hypertension: 2024 ESC new recommendations

• Blood pressure (BP) should be measured using a validated and calibrated device, applying the correct technique, and following a consistent approach for each patient.
• Measuring BP outside the office is recommended for diagnostic purposes, particularly because it can detect both white coat hypertension and masked hypertension.
• If out-of-office measurement is not feasible, BP should be confirmed with repeated in-office measurements using the correct standardized technique.
• Most automatic oscillometric monitors have not been validated for BP measurement in atrial fibrillation (AF) cases; in these circumstances, consider measuring BP manually via the auscultatory method, when possible.
• Orthostatic hypotension (≥20 mmHg drop in systolic BP and/or ≥10 mmHg drop in diastolic BP 1 and/or 3 minutes after standing) should be assessed at least during the initial diagnosis of high BP or hypertension, and later if suggestive symptoms appear. The patient should lie down or sit for 5 minutes before the test

• A risk-based approach is recommended, considering individuals with moderate or severe chronic kidney disease, established cardiovascular disease, hypertension-mediated organ damage, diabetes mellitus, or familial hypercholesterolemia as being at higher risk for cardiovascular events.
• Regardless of age, individuals with elevated BP and a SCORE2 or SCORE2-OP cardiovascular risk of ≥10% should be considered at higher risk.
• For estimating cardiovascular risk in patients with type 2 diabetes mellitus and elevated BP, the SCORE2-Diabetes tool should be considered, especially for those <60 years old.
• Pregnancy complications are sex-specific risk modifiers and should be considered to up-classify patients with elevated BP and borderline 10-year CVD risk (5% to <10%).
• High-risk ethnicities (e.g., South Asian), family history of premature atherosclerotic disease, socioeconomic deprivation, inflammatory autoimmune disorders, HIV, and severe mental illness are shared risk modifiers for both sexes. These factors should be considered to classify individuals with elevated BP and increase their 10-year cardiovascular risk (5% to <10%).
• If treatment decisions to lower BP based on risk remain unclear after evaluating non-traditional cardiovascular risk modifiers and predicted 10-year cardiovascular risk, coronary artery calcium (CAC) scoring, carotid or femoral plaque via ultrasound, high-sensitivity cardiac troponin biomarkers, B-type natriuretic peptide, or arterial stiffness (pulse wave velocity) can be considered to improve risk stratification for patients with borderline 10-year cardiovascular risk (5% to <10%) after shared decision-making and cost considerations.

• Regular BP monitoring with the following frequency:

     -Adults <40 years old: at least every 3 years.

     -Adults ≥ 40 years old: at least once a year.

• For people with elevated BP who do not meet treatment criteria, BP should be reassessed and risk reevaluated within a year.

• Other forms of hypertension screening, such as systematic detection, self-examinations, and screenings by non-medical personnel, may be considered depending on feasibility in different countries and healthcare systems.
• In individuals with higher cardiovascular risk, whose office BP is between 120–139/70–89 mmHg, ambulatory BP monitoring (ABPM) and/or home BP monitoring (HBPM) is recommended. If not feasible, repeated in-office BP measurements should be done over more than one visit.
• For patients with apparent resistant hypertension, treatment adherence should be assessed (via direct observation or detecting prescribed drugs in blood or urine samples) if resources are available.
• If moderate-to-severe chronic kidney disease is diagnosed, serum creatinine, estimated glomerular filtration rate (eGFR), and urine albumin-to-creatinine ratio (ACR) measurements should be repeated at least one a year.
• Coronary artery calcium scoring may be considered in patients with elevated BP or hypertension when it is likely to change patient management.
• Patients with resistant hypertension should be referred to specialized hypertension centers for further testing.
•  Patients with hypertension who show signs, symptoms, or medical history suggesting secondary hypertension should be appropriately screened.
• Primary aldosteronism screening via renin and aldosterone measurements should be considered for all adults with confirmed hypertension (BP ≥ 140/90 mmHg).

Here are some key recommendations from the 2024 ESC Guidelines for managing high BP and hypertension:

• To better predict adult hypertension and associated cardiovascular risk, timely BP monitoring should be done during late childhood and adolescence, especially if one or both parents have hypertension.
• Sugar intake should be restricted, and sugary drinks (e.g., sodas, fruit juices) discouraged from early childhood.
• In individuals with hypertension who are free of moderate-to-severe chronic kidney disease and consume high sodium levels, increasing potassium intake by 0.5 to 1.0 grams per day is recommended. Consider replacing regular salt with potassium-enriched salt or increasing fruit and vegetable consumption.
• For adults with elevated BP and low-to-moderate cardiovascular risk (less than 10% over 10 years), lifestyle changes are recommended to lower BP levels.
• In adults with confirmed elevated BP (≥130/80 mmHg) and high cardiovascular risk, pharmacological treatment is recommended after 3 months of lifestyle changes.
• BP-lowering treatment should only be considered from ≥140/90 mmHg in individuals who meet any of the following criteria:

- Symptomatic orthostatic hypotension (BP drop upon standing) before treatment

- Age 85 or older

- Clinically significant moderate-to-severe frailty

- Limited life expectancy (less than 3 years).

• For patients who cannot tolerate BP-lowering treatment well and cannot achieve a systolic BP of 120–129 mmHg, targeting a systolic BP level "as low as reasonably achievable" (ALARA principle) is recommended.

Effective management of hypertension requires a comprehensive approach that includes patient education, technological tools, and multidisciplinary collaboration. Below are several recommendations for improving blood pressure control, from the importance of clear doctor-patient communication to the use of home monitoring devices and the redistribution of responsibilities among healthcare professionals. These approaches not only simplify treatment but also enhance patient adherence to it.

• A clear discussion with patients about cardiovascular risk and treatment benefits, tailored to their needs, is recommended as part of hypertension management.
• Motivational interviewing techniques are suggested to help patients control their BP and improve treatment adherence at hospitals and community health centers.
• Physician-patient online communication is an effective tool that should be considered in primary care, including reporting home BP readings to physicians.
• Home BP monitoring is recommended as it helps better manage hypertension.
• Self-measurement of BP is recommended because, when done correctly, it has positive effects on accepting the hypertension diagnosis, patient empowerment, and treatment adherence.
• To manage hypertension more effectively, a multidisciplinary approach that safely delegates certain tasks from physicians to other healthcare professionals is recommended. This helps improve BP control and ensures more efficient care.

At SCHILLER, we are committed to helping healthcare professionals care for patients with high blood pressure and/or hypertension. That’s why we offer our DS-20 Diagnostic Station, an all-in-one device that seamlessly integrates EKG (including a 6-minute step test), blood pressure, and vital signs measurements into a single system. This Swiss-quality device provides the following features:

Most vital signs and physical assessment tools are united in one device: NIBP, TEMP, SpO2, 3-lead EKG.

Large 18” interactive touchscreen with intuitive guidance and easy-to-use interface.

Highest diagnostic EKG quality with a 32,000 Hz sampling rate (12-lead).

Bidirectional communication through Wi-Fi and Ethernet connection.

REFERENCE

John William McEvoy et al. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. European Heart Journal (2024) 00, 1–107 https://doi.org/10.1093/eurheartj/ehae178