Blood pressure standards have been tightened. New alarm value. It concerns millions of Poles

• New blood pressure guidelines presented by the European Society of Cardiology
• In addition, there is a new category of blood pressure called "high blood pressure"
• Experts have pointed out that the higher the blood pressure, the higher the relative risk of cardiovascular disease, including atherosclerosis.

In 2024, new blood pressure guidelines were presented at the European Society of Cardiology congress. These guidelines continue to define hypertension as an office systolic blood pressure of ≥140 mmHg or a diastolic blood pressure of ≥90 mmHg .

However, a new category of blood pressure has been introduced called “raised blood pressure.” This is defined as an office systolic pressure of 120–139 mmHg or a diastolic pressure of 70–89 mmHg.

Another significant 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 medications. There are several important caveats to this recommendation, the report notes, including:

• the requirement that treatment to target blood pressure is well tolerated by the patient,
• the fact that milder blood pressure targets may be considered for 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 a 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 patients with high blood pressure

In addition, the guidelines indicate that the higher the blood pressure, the higher the relative risk of cardiovascular disease, including atherosclerosis. In turn, the risk of adverse cardiovascular outcomes increases with sustained increases in systolic and diastolic pressure.

As reported, simply using blood pressure thresholds for hypertension to allocate treatment would lead to undertreatment of many high-risk patients.

If the blood pressure in the doctor's office is 120–139/70–89 mmHg , the patient is considered to have elevated blood pressure and it is recommended to further differentiate the risk of cardiovascular disease in order 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 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 agents should be initiated for 3 months. Drug therapy is then 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 prompt addition of drug therapy, if necessary within 3 months, to avoid therapeutic inertia. In those with blood pressure 120–129/70–79 mmHg, sustained and intensive lifestyle intervention is preferred.

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