Key result
Lowering diastolic BP threshold to 70 mmHg reclassifies ~70% of optimal individuals without identifying higher risk.
Why the study?
The relevance of the new 2024 ESC blood pressure classification with a lowered diastolic threshold of 70 mmHg for cardiovascular risk stratification in low-risk primary prevention remains uncertain.
Does the 2024 ESC blood pressure classification (diastolic threshold 70 mmHg) identify a higher-risk phenotype in a low-risk primary prevention cohort compared to the 2018 classification?
Cross-Sectional (n=1,394)
Does the 2024 ESC blood pressure classification (diastolic threshold 70 mmHg) identify a higher-risk phenotype in a low-risk primary prevention cohort compared to the 2018 classification?
The 2024 ESC guideline's lower diastolic threshold of 70 mmHg for elevated blood pressure causes substantial reclassification without identifying a higher-risk phenotype in primary prevention.
Answers are grounded in this paper and cite their sources.
New ESC elevated BP category needs validation in low-risk adults; leaves open its value for primary prevention risk stratification.
In 2024, the European Society of Cardiology (ESC) hypertension guidelines introduced an "elevated blood pressure" category (120-139 and/or 70-89 mmHg), lowering the diastolic threshold from 85 to 70 mmHg. Its relevance for cardiovascular risk stratification in low-risk primary prevention remains uncertain. We conducted a cross-sectional study of 1394 adults undergoing standardized preventive health assessment in France, with office blood pressure (BP) measured using a validated oscillometric device. Participants were classified by ESC/ESH 2018 and ESC 2024 definitions. We quantified category shifts and compared the clinical, lifestyle and biological profile of individuals reclassified from 2018 optimal to 2024 elevated on the basis of diastolic BP ≥70 mmHg (systolic BP < 120 mmHg) vs. those remaining nonelevated. SCORE2, available in 61% of participants, was used as a supporting risk estimate. ESC 2024 classified 10.0% as nonelevated, 64.2% as elevated and 25.8% as hypertensive; 70% of previously "optimal" individuals became "elevated." Compared with nonelevated peers, the diastolic-only reclassified group differed only in age (45.5 vs. 42.7 years; P = 0.007), with no difference in sex, body mass index, lifestyle, cardiovascular history or biomarkers. Their slightly higher SCORE2 was attributable to higher systolic BP and age, and was no longer significant after adjustment for systolic BP. By contrast, individuals reclassified from normal to elevated had a less favorable cardiometabolic profile. Lowering the diastolic threshold to 70 mmHg produced substantial reclassification but did not identify an independent higher-risk phenotype when systolic BP remained < 120 mmHg, questioning the relevance of such a low diastolic threshold for elevated BP in the new ESC 2024 classification. Prospective outcome studies are needed.
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Lepoittevin et al. (2026) conducted a cross-sectional in Elevated blood pressure (n=1,394). Diastolic BP ≥70 mmHg (ESC 2024 elevated BP classification) vs. Nonelevated BP (ESC/ESH 2018 classification) was evaluated on Differences in clinical, lifestyle, and biological profile (including SCORE2) (p=0.007). Lowering the diastolic threshold to 70 mmHg reclassified 70% of previously optimal individuals as elevated, but did not identify an independent higher-risk phenotype when systolic BP was <120 mmHg.
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