Guidelines Comparison
The 2024 ESC guidelines introduce a simplified, three-tiered system:

Non-elevated: <120/70 mmHg (no drug treatment recommended)

Elevated: 120-139/70-89 mmHg (drug treatment considered based on CVD risk and follow-up BP)

Hypertension: ≥140/90 mmHg (prompt treatment recommended for all)

The ESC avoids terms like "normal" or "optimal" because even in the lowest BP range, CVD risk still increases with rising BP. They retain the traditional ≥140/90 mmHg threshold for hypertension as this is where treatment clearly shows net benefit. The "elevated" category acknowledges that treatment can benefit higher-risk individuals even below this traditional threshold, based on recent trial data.

Here's a summary comparison:

Feature	ESC 2024	ESH 2023	ACC/AHA 2017
BP Classification	3 tiers: Non-elevated, Elevated, Hypertension	6 tiers: Optimal, Normal, High-normal, Grade 1-3 Hypertension	4 tiers: Normal, Elevated, Hypertension Stage 1-2
Hypertension Threshold	≥140/90 mmHg	≥140/90 mmHg (but treatment at ≥160 mmHg for >80 years old)	≈130/80 mmHg (for high-risk individuals)
Staging Based on Complications	No	Yes	No
Rationale	Simplified for treatment decisions; acknowledges risk continuum	Detailed classification and staging for prognosis	Lower threshold reflecting earlier trial data in high-risk individuals

The ESC 2024 guidelines prioritize simplicity and treatment decisions, while the ESH 2023 guidelines provide a more prognostic classification. The ACC/AHA 2017 guidelines represent an earlier approach with a lower hypertension threshold based on then-available data.

 

 

 

 

 

 

 

Comparison of Resistant Hypertension Guidelines (ESC 2024, ESH 2023, ACC/AHA 2017)

Feature	ESC 2024	ESH 2023	ACC/AHA 2017
Spironolactone	Class IIa	Class II	Favored, no formal recommendation
Renal Denervation	Consider if: Performed at experienced center after risk/benefit discussion and multidisciplinary assessment Class IIb) Do not use if: eGFR < 40 mL/min/1.73m² (Class III)	Consider if eGFR > 40 mL/min/1.73m² (Class II)	Not addressed

Reference:

McCarthy CP, Bruno RM, Rahimi K, Touyz RM, McEvoy JW. What Is New and Different in the 2024 European Society of Cardiology Guidelines for the Management of Elevated Blood Pressure and Hypertension? Hypertension. 2024 Dec 31.