An international expert panel, co-chaired by Dr. Rhian Touyz of the RI-MUHC, recommends various measures to reduce cardiovascular risks for a wider range of patients
The European Society for Cardiology (ESC) has just released new guidelines for managing high blood pressure and hypertension. These guidelines introduce a new category called “elevated blood pressure,” set more ambitious treatment goals for patients receiving BP lowering medication, and, for the first time, suggest using a technique called renal denervation to treat certain types of hypertension.
High blood pressure, or hypertension, is one of the most significant risk factors for heart attacks and strokes, collectively known as cardiovascular disease. In Canada, nearly 25% of adults have hypertension. Developed by an international panel of experts, including co-chairs Dr. Rhian Touyz from the Research Institute of the McGill University Health Centre (RI-MUHC) and Dr. Bill McEvoy from the University of Galway in Ireland, the ESC Hypertension guidelines aim to help more patients reach recommended blood pressure targets and increase access to medications that can lower blood pressure, based on the latest clinical research. They may influence future recommendations from other societies around the world, including Canada and the USA.
“While the 2024 Guidelines still define hypertension as a blood pressure of 140/90 mmHg or higher, we’ve added a new category called ‘Elevated BP’ for readings between 120-139/70-89 mmHg,” explains Dr. Touyz, Executive Director and Chief Scientific Officer at the RI-MUHC and Canada Research Chair in Cardiovascular Medicine at McGill University. “This change is a paradigm shift that will allow us to take more proactive steps in treating those at higher risk for heart disease, ultimately saving lives by preventing premature deaths.”
“This new category of elevated blood pressure recognises that people do not go from normal BP to hypertensive overnight,” adds Dr. McEvoy. “It is in most cases a steady gradient of change, and different subgroups of patients – for example those at a higher risk of developing cardiovascular disease (e.g., people living with diabetes) – could benefit from more intensive treatment before their BP reaches the traditional threshold of hypertension.”
Stella Daskalopoulou, MD, PhD, was the only other Canadian task force member and co-author of these international guidelines. Dr. Daskalopoulou is the immediate past Hypertension Canada Guidelines Co-chair, and a senior scientist in the Cardiovascular Health Across the Lifespan Program at the RI-MUHC.
In a nutshell, the 2024 ESC Guidelines:
- Introduce a new category of “Elevated BP” which is defined as a BP 120-139/70-89 mmHg, to target more patients at risk for heart attack and stroke.
- Introduce a new systolic BP treatment target range of 120-129 mmHg for most patients receiving BP-lowering medication, with the important proviso that the new target requires that treatment is well tolerated.
- Provide pragmatic recommendations to avoid patients becoming symptomatic from overtreatment and to pursue a BP that is ‘as low as reasonably achievable’ in patients who are unable to tolerate or who opt out of the intensive treatment target.
- Make recommendations on the use of renal denervation for patients with resistant hypertension who have BP that is uncontrolled despite the appropriate drug combination and who express a preference to undergo renal denervation after a shared risk-benefit discussion and multidisciplinary assessment.
- Introduce recommendations for new lifestyle options to help lower BP, such as new guidance on exercise and potassium supplementation.
- Highlight the importance of sex and gender differences in hypertension.
For more information, read the full press release. The complete guidelines are published in the European Heart Journal, ehae178, https://doi.org/10.1093/eurheartj/ehae178