Treatment of hypertension in Norway in relation to new European hypertension guidelines

New guidelines for high blood pressure (BP) by the European Society of Cardiology (ESC) now consider BP of 120–140/70–90 mmHg to be elevated (“high”) BP and recommend pharmacotherapy for BP > 130/80 mmHg if the estimated 10-year risk of cardiovascular events exceeds 10%, regardless of age. These recommendations are given with reference to two meta-analyses, but the studies included in the referred meta-analyses lack direct relevance, as patients in the first meta-analysis had established hypertension and several cardiovascular risk conditions. Further, the estimation of risk levels in the second meta-analysis was not done a priori with the recommended SCORE2 risk tool, but through a post hoc analysis of cardiovascular death in the placebo group. We argue that no randomized study has provided BP treatment based on such risk algorithms, nor from healthy participants with “elevated BP” (120–139/70–89 mmHg). A further problem is the use of a fixed risk threshold of 10% regardless of age, which will shift treatment to older patients without any major risk factors, while younger individuals with early onset of high BP and other metabolic syndrome characteristics usually will have a 10-year estimated cardiovascular risk far below this threshold, thus treatment may be delayed. This concept of the 2024 ESC hypertension guidelines is not evidence-based and should, in our opinion, not be implemented in Norway or in any other country. Norwegian doctors should follow the National Directorate of Health’s guidelines with age-adjusted intervention thresholds and consult European Society of Hypertension guidelines if they need to consider more extensive patient recommendations.