Under the 2024 ESC categories, most patients below the hypertension threshold became 'elevated'

Design

Retrospective cross-sectional study at one family health centre

Population

882 adults registered at a family health centre in Izmir, Türkiye

Primary outcome

Change in office blood pressure classification, 2018 vs 2024 ESC

Effect

53.4% elevated under 2024; treated at target fell from 53.5% to 30.8%

The 2024 European Society of Cardiology guideline kept 140/90 mmHg as the threshold for hypertension but replaced the old optimal, normal and high-normal bands with a single 'elevated' category below it, managed by cardiovascular risk, and set lower treatment targets. This retrospective cross-sectional study at a family health centre in Izmir applied both the 2018 ESC/ESH and the 2024 ESC schemes to 882 adults, using SCORE2 and SCORE2-OP for risk.

Under the old scheme, 70.5% sat in the optimal to high-normal range; under the new one only 17.1% were non-elevated. More than half of all patients (53.4%) were classed as elevated, including 75.7% of those previously below the hypertension threshold. The proportion of treated hypertensive patients at target fell from 53.5% to 30.8%.

The practical consequence is workload. A risk-based 'elevated' category asks the practice to calculate cardiovascular risk and decide on lifestyle or drug treatment for many more people, and the lower targets mean more treated patients need intensification. This is one centre in Türkiye, so the proportions will vary, and practices following national guidelines that use different categories, including in India, are not bound by the ESC scheme. But any practice adopting it should plan for the shift.

• Expect many patients previously labelled normal or high-normal to fall into the 2024 'elevated' category.
• For elevated readings, calculate cardiovascular risk to decide between lifestyle advice and drug treatment.
• Lower targets in the 2024 scheme mean fewer treated patients count as controlled; review those near target.
• Confirm readings out of the office before reclassifying or intensifying treatment.
• Plan recall capacity before adopting the new categories across a practice list.

Why it matters

The new categories turn a large group of 'normal' patients into people who need a risk calculation and a plan.

Don't overread it

This is a single-centre reclassification exercise; it does not show that the 2024 approach improves outcomes.

The statistics, in plain English

These are reclassification percentages in one practice, not outcomes, so they show workload rather than benefit. The study cannot tell us whether managing the 'elevated' group differently prevents events.

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