The 2024 ESC categories moved most patients below 140/90 into an elevated blood pressure group

Design

Retrospective cross-sectional study in one family health centre

Population

882 adults registered at a primary care centre in Izmir, Turkey

Primary outcome

Change in office blood pressure category, 2018 ESC/ESH vs 2024 ESC

Effect

Non-elevated 70.5% to 17.1%; treated at target 53.5% to 30.8%

The 2024 European Society of Cardiology hypertension guideline kept the diagnostic threshold at 140/90 mmHg but replaced the old optimal, normal and high-normal bands with a new elevated blood pressure category below it, managed according to cardiovascular risk. It also set lower treated targets.

A retrospective study at a family health centre in Izmir, Turkey, reclassified 882 adults. Under the 2018 ESC/ESH bands, 70.5% sat in the optimal to high-normal range; under the 2024 scheme only 17.1% were non-elevated. More than half of all patients (53.4%) fell into the elevated group, including three-quarters of those previously below the hypertension threshold. Among treated patients, the share at target fell from 53.5% to 30.8%.

The study is from one practice and does not measure outcomes. But it shows the scale of change: a primary care list will contain far more people needing a risk assessment and follow-up plan, and far fewer treated patients will count as controlled.

Indian guidelines may differ from the ESC scheme, so check which framework your practice follows before relabelling patients.

• Under the 2024 ESC scheme, expect about half of adults to fall into the elevated blood pressure group
• Use a cardiovascular risk score to decide who in the elevated group needs closer follow-up or treatment
• Expect fewer treated patients to meet the stricter target; plan reviews accordingly
• Confirm raised readings with home or ambulatory measurement before acting
• Check which national guideline your practice follows before relabelling patients

Why it matters

A guideline change can double a practice's follow-up workload without anyone's blood pressure changing.

Don't overread it

This single-practice study cannot show that the new categories improve patient outcomes.

The statistics, in plain English

These are reclassification proportions from one practice, not outcomes. They show how labels shift, not whether the new approach prevents more strokes or heart attacks.

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