European Hypertension Guidelines: Similarities and What the Practicing Physician Should Keep in Mind

The European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) have recently released separate guidelines for the management of arterial hypertension, published less than 12 months apart. Many practicing physicians, especially in the primary care setting, might find it challenging to thoroughly read the two lengthy documents and, most importantly, might get confused in areas of discrepancies. This review compares the two sets of recommendations using the BEST framework, which focuses on Blood pressure (BP) measurement and monitoring, Establishing the diagnosis and classifying hypertension, Stratified patient assessment, and Therapeutic decisions, providing a structured overview of their areas of agreement and divergence and aiming at highlighting what the practicing physician should keep in mind. In general, the main recommendations made by the 2023 ESH and 2024 ESC guidelines regarding hypertension diagnosis and management present many similarities: office diagnostic threshold at 140/90 mmHg (multiple measurements and visits), primary role of out-of-office BP monitoring in confirming hypertension diagnosis and in follow-up of treated patients, cardiovascular (CV) risk assessment based on risk calculators and risk modifiers, initiation of drug treatment based on BP level and CV risk, treatment strategy based on steps and combination therapy, and treatment target for most patients of <130/80 mmHg.