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March 17, 2025Blood PressureOpen Access

Management of ‘Elevated’ blood pressure according to the 2024 European Society of Cardiology Guidelines: lack of supportive evidence and high risk of excessive treatment

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Why the study?

Does antihypertensive treatment prevent cardiovascular, cerebral, or renal complications in healthy individuals with 'Elevated' blood pressure (120-139/70-89 mmHg)?

Population

Healthy individuals with 'Elevated' blood pressure without previous cardiovascular events.

Design

Editorial

Key result

The 2024 ESC guidelines recommending antihypertensive treatment for 'Elevated' blood pressure (120-139/70-89 mmHg) lack supportive evidence from randomized controlled trials and risk excessive treatment.

Authors

SKSverre E. KjeldsenMBMattias BrunströmMBMichel Burnier

Discussion

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Member takes

Overview

Urges restraint in treating elevated BP per 2024 ESC guidelines; leaves open the need for RCTs to establish benefit.

Structured PICO

Does antihypertensive treatment prevent cardiovascular, cerebral, or renal complications in healthy individuals with 'Elevated' blood pressure (120-139/70-89 mmHg)?

P
Population
Healthy individuals with 'Elevated' blood pressure (120-139/70-89 mmHg) without previous cardiovascular events (primary prevention).
I
Intervention
Antihypertensive or blood pressure lowering treatment

This editorial challenges the 2024 ESC Hypertension Guidelines, arguing that recommending antihypertensive therapy for 'Elevated' BP (120-139/70-89 mmHg) lacks robust RCT evidence and risks overburdening healthcare systems.

Limitations

  • This is an editorial and does not present new primary clinical trial data.
  • The arguments are based on critical appraisal of existing meta-analyses and guidelines.

Cite This Study

Kjeldsen et al. (2025) conducted an editorial in Elevated blood pressure. Antihypertensive treatment was evaluated. The 2024 ESC guidelines recommending antihypertensive treatment for 'Elevated' blood pressure (120-139/70-89 mmHg) lack supportive evidence from randomized controlled trials and risk excessive treatment.

synapsesocial.com/papers/6aac9c2f4963efd150c0cff5https://doi.org/10.1080/08037051.2025.2480608
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol2002 · 5,432 citations
  2. 22024 ESC Guidelines for the management of elevated blood pressure and hypertension2024 · 2,312 citations
  3. 3Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis2021 · 1,061 citations
  4. 4The SPRINT study: Outcome may be driven by difference in diuretic treatment demasking heart failure and study design may support systolic blood pressure target below 140 mmHg rather than below 120 mmHg2016 · 38 citations
  5. 5SCORE2-OP risk prediction algorithms: estimating incident cardiovascular event risk in older persons in four geographical risk regions2021 · 621 citations