10 Estrategias Para HAS ESC 2024

European Heart Journal (2024) 00, 1–2
https://doi.org/10.1093/eurheartj/ehae646
ESC News
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The ‘ten commandments’ for the 2024 European
Society of Cardiology guidelines on elevated
blood pressure and hypertension
1
Cian P. McCarthy , Rhian M. Touyz2,3,*, and John W. McEvoy4,5,6,*
1
Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; 2Department of Medicine, McGill University, 1001 Decarie Boulevard, Montreal,
Quebec H4A 3J1, Canada; 3Research Institute of the McGill University Health Centre, McGill University, 2155 Guy Street, Montreal, Quebec H3H 2R9, Canada; 4Cardiology Department,
Galway University Hospital and University of Galway School of Medicine, Newcastle Road, Galway H91 YR71, Ireland; 5National Institute for Prevention and Cardiovascular Health, Croi
House, Moyola Ln, Newcastle, Galway H91FF68, Ireland; and 6Johns Hopkins Ciccarone Centre for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, 601 North
Caroline Street, Baltimore, MD 21287, USA
The 2024 European Society of Cardiology (ESC) guidelines for the developed by a multidisciplinary team including patient representa
management of elevated blood pressure (BP) and hypertension were tives.1 These ‘ten commandments’ summarize the guideline (Figure 1).
Figure 1 Summarizing the ‘ten commandments’ of the 2024 ESC Clinical Practice Guidelines for the Management of Elevated Blood Pressure and Hypertension.
N.B., for the 5th commandment, drug treatment is only for persons with high CVD risk and a repeat confirmed BP of 130/80 mmHg or more after 3 months of
lifestyle measures. N.B., For the 5th commandment, drug treatment is only for persons with high CVD risk and a repeat confirmed BP of 130/80 mmHg or more
after 3 months of lifestyle measures. ALARA, as low as reasonably achievable; CVD, cardiovascular disease; SBP, systolic blood pressure
* Corresponding authors. Email: [email protected] (J.W.M.); Email: [email protected] (R.M.T.)

Published by Oxford University Press on behalf of the European Society of Cardiology 2024.
2 CardioPulse
(1) Blood pressure classification: A new BP classification is intro reducing sodium intake (<2 g/day), healthy diet, maintain normal
duced: non-elevated (office BP < 120/70 mmHg), elevated BP body-mass index, smoking cessation, and limiting alcohol intake.
(office BP 120–139/70–89 mmHg), and hypertension (office (8) Blood pressure target: For patients on treatment, a systolic BP
BP ≥ 140/90 mmHg). target of 120–129 mmHg [including for non-frail older individuals
(2) Diagnosis: Out-of-office BP measurement is recommended for (<85 years)] is recommended. If not possible/tolerated—or in
the diagnosis and management of elevated BP and hypertension persons ≥ 85 years or with symptomatic orthostasis, moderate-
when logistically and economically feasible (preferred over office to-severe frailty, or limited lifespan—target a BP that is as low
BP). as reasonably achievable (ALARA).
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(3) Risk assessment: Risk assessment is recommended for persons (9) Resistant hypertension: For resistant hypertension, spironolac
with elevated BP to identify high cardiovascular disease (CVD) tone (eplerenone if not tolerated), followed by beta blockers
risk individuals. Risk assessment follows a step-wise approach: and subsequently, additional medications (e.g. alpha blockers)
(i) assess for high CVD risk conditions (e.g. established CVD), should be considered. Renal denervation may also be considered.
(ii) predict 10-year risk of CVD, (iii) evaluate for sex-specific and (10) Multidisciplinary team: Multidisciplinary approaches are strongly
shared risk modifiers, and (iv) consider additional testing with recommended to improve BP control, including task-shifting
risk tools. away from physicians.
(4) Elevated BP with low CVD risk: Lifestyle measures are recom
mended for elevated BP and low CVD risk (no high CVD risk con
ditions and 10-year predicted CVD risk < 5% or borderline risk of Declarations
5–<10% without risk modifiers or abnormal risk tests).
(5) Elevated BP with high CVD risk: For elevated BP and high CVD Disclosure of Interest
risk (high risk CVD conditions or 10-year risk ≥ 10% or border C.P.M. is supported by a National Heart, Lung, and Blood Institute
line risk of 5–<10% with risk modifiers or abnormal risk tests), Career Development Award (K23HL167659) and has received con
lifestyle measures are recommended initially and after 3 months, sulting fees/honorarium from Roche Diagnostic, Abbott Laboratories,
if BP remains ≥ 130/80 mmHg, pharmacological BP-lowering treat New Amsterdam Pharma, and HeartFlow, Inc. The remaining authors
ment is recommended. have nothing to disclose.
(6) Hypertension: Lifestyle and pharmacological BP-lowering treat
ment are recommended for hypertension. Single-pill double
combination treatment is recommended initially for most patients.
Reference
1. McEvoy JW, McCarthy CP, Bruno RM, Brouwers S, Canavan MD, Ceconi C, et al. 2024
(7) Lifestyle management: Updated lifestyle recommendations in ESC Guidelines for the management of elevated blood pressure and hypertension.
clude aerobic and resistance training, increasing potassium intake, Eur Heart J. 2024:ehae178. https://doi.org/10.1093/eurheartj/ehae178

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European Heart Journal (2024) 00, 1–2

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* Corresponding authors. Email: [email protected] (J.W.M.); Email: [email protected] (R.M.T.)

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