ESC 2024 hypertension guidelines: key recommendations

Official guideline2024 ESC Guidelines for the management of elevated blood pressure and hypertension. ESC, 2024.
Read the official guideline · Checked for a newer edition on 2026-10-20
We do not reproduce the guideline text — this page is an independent summary.

Who it applies to

Adults with elevated blood pressure or hypertension managed in primary care, specialist, and hospital settings.

Key recommendations

Blood pressure should be classified into three categories: non-elevated, elevated blood pressure, and hypertension, based on confirmed office and out-of-office readings.
Out-of-office blood pressure measurement, using home or ambulatory monitoring, is recommended to confirm the diagnosis of hypertension whenever feasible.
A standardized blood pressure target of around 120-129 mmHg systolic is recommended for most treated adults, provided treatment is well tolerated.
Initiation of antihypertensive drug treatment is recommended for patients with confirmed hypertension, and should be considered in elevated blood pressure when cardiovascular risk is high.
Lifestyle interventions including sodium reduction, weight management, physical activity, and limiting alcohol are recommended at all blood pressure categories.
Initial combination therapy with two antihypertensive drugs, usually a renin-angiotensin system blocker plus a calcium channel blocker or diuretic, is preferred over starting with monotherapy in most patients.
Single-pill combinations are recommended to improve adherence to long-term antihypertensive therapy.
Cardiovascular risk assessment should incorporate total risk estimation rather than blood pressure values alone when deciding on treatment intensity.
Device-based therapies such as renal denervation may be considered in selected patients with resistant hypertension after specialist evaluation.
Screening for secondary causes of hypertension is recommended in patients with resistant hypertension or suggestive clinical features, particularly younger patients.

What is new in this edition

Introduction of the elevated blood pressure category between normal and hypertension
Lower, more uniform systolic blood pressure target of approximately 120-129 mmHg for most patients
Stronger emphasis on initial combination drug therapy rather than stepwise monotherapy
Greater emphasis on out-of-office blood pressure measurement for diagnosis
Expanded discussion of renal denervation as a treatment option in resistant hypertension

Practice points for students

Remember the three-tier classification: non-elevated, elevated blood pressure, and hypertension, rather than the older two-tier normal/hypertension split.
Confirm diagnosis with home or ambulatory monitoring rather than relying on a single office reading.
Most patients now start on two drugs together rather than one, to reach target faster.
The default target is lower than many trainees expect, around 120-129 mmHg systolic if tolerated.
Always consider secondary causes in young patients or those with resistant hypertension.

Condition

Hypertension