Elevated Blood Pressure: A New Definition in Hypertension Guidelines and Its Impact on Cardiovascular Risk and Treatment

Abstract

Purpose: Hypertension is the most common chronic cardiovascular disorder and a leading risk factor for morbidity and mortality. Early recognition and management are essential for prevention. The 2024 ESC Guidelines introduced "elevated blood pressure" (systolic BP 120–139 mmHg and/or diastolic BP 70–89 mmHg) as a new category. The new classification is just pronounced within ESC 2024 gave the totally new insight off approach some treatment.

Main: Elevated BP represents an intermediate stage between normal BP and hypertension, highlighting the continuum of cardiovascular risk. This category emphasizes risk stratification by integrating BP levels with global CVD risk prediction models (SCORE2, SCORE2-OP, SCORE2-Diabetes) and considering sex-specific and shared non-traditional risk modifiers. Treatment strategies vary according to risk: lifestyle measures are first-line for low-risk individuals, while pharmacological therapy is reserved for those with high-risk conditions, predicted 10-year CVD risk ≥10%, or borderline risk (5–10%) with additional modifiers or abnormal test results.

Finding: Evidence supports the benefit of lifestyle interventions in reducing long-term CVD risk among patients with elevated BP. Pharmacological treatment, when indicated, effectively reduces outcomes but should be initiated after a 3-month trial of lifestyle changes in most cases. Exceptions to intensive BP-lowering targets include very old or frail adults, those with symptomatic orthostatic hypotension, advanced CKD, or limited life expectancy, where individualized targets are required.

Conclusion: The concept of elevated BP shifts management from fixed thresholds to risk-based strategies, promoting early prevention, individualized assessment, and targeted treatment to improve outcomes while minimizing overtreatment.