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  • Expert Recommendation
  • Published:

European guidelines for hypertension in 2024: a comparison of key recommendations for clinical practice

Nature Reviews Cardiology volume 22, pages 675–688 (2025)Cite this article

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Abstract

Hypertension is the most prevalent modifiable risk factor for cardiovascular disease and for cardiovascular and all-cause mortality globally. Suboptimal control of elevated blood pressure places a substantial burden on health-care systems worldwide. Several factors contribute to this suboptimal control, such as limited awareness of hypertension, lack of appropriate diagnosis and poor control of blood pressure among those with a diagnosis. These factors can be due to patient non-adherence to treatment, inertia among health-care professionals and low uptake and implementation of clinical guideline recommendations. From 2003 to 2018, the European Society of Hypertension and the European Society of Cardiology jointly published four sets of guidelines on hypertension. However, the two societies released separate guidelines on hypertension in 2023 and 2024, respectively. These two sets of European guidelines agree on most recommendations, but some differences have been identified. In this Expert Recommendation, we highlight the key consensus recommendations from the two guidelines; compare differing approaches to the definition, classification, diagnosis and treatment of hypertension; and aim to help health-care professionals in their decision-making to improve the management of hypertension and to reduce the burden of hypertension-associated outcomes and premature deaths.

Key points

  • Diagnose hypertension if office blood pressure (BP) is ≥140/90 mmHg, confirmed by repeated office BP measurements during the visit and across multiple visits.

  • Use 24-h ambulatory or home BP monitoring to confirm the diagnosis of hypertension and identify phenotypes such as masked or white-coat hypertension.

  • Consider the risk of cardiovascular disease (CVD) and treatment initiation if office systolic BP does not meet the hypertension threshold but is 130–139 mmHg, particularly in patients with CVD or who are at high risk of CVD.

  • For most patients, aim for an office systolic BP of 120–129 mmHg and a diastolic BP of 70–79 mmHg, if tolerated; prioritize frailty over chronological age and consider personalized, lenient BP targets (such as <140 mmHg) for older (age >80 years) or frail patients.

  • Recommend lifestyle changes, including diet, physical activity and weight management, for all patients, regardless of their BP.

  • Start with two-drug regimens and escalate to three-drug combinations, preferably in a single pill, using a renin–angiotensin system inhibitor plus a calcium channel blocker or thiazide or thiazide-like diuretic for most patients with hypertension.

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Fig. 1: Definition of hypertension and comparison of BP categories.
Fig. 2: BP treatment thresholds and targets.
Fig. 3: Treatment algorithm for general patients with hypertension.

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References

  1. Magnussen, C. et al. Global effect of modifiable risk factors on cardiovascular disease and mortality. N. Engl. J. Med. 389, 1273–1285 (2023).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet 398, 957–980 (2021).

    Article  PubMed Central  Google Scholar 

  3. McEvoy, J. W. et al. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. Eur. Heart J. 45, 3912–4018 (2024).

    Article  PubMed  Google Scholar 

  4. Mancia, G. et al. 2023 ESH guidelines for the management of arterial hypertension the task force for the management of arterial hypertension of the European Society of Hypertension: endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J. Hypertens. 41, 1874–2071 (2023).

    Article  CAS  PubMed  Google Scholar 

  5. Lewington, S. et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 360, 1903–1913 (2002).

    Article  PubMed  Google Scholar 

  6. Whelton, S. P. et al. Association of normal systolic blood pressure level with cardiovascular disease in the absence of risk factors. JAMA Cardiol. 5, 1011–1018 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  7. Arvanitis, M. et al. Linear and nonlinear Mendelian randomization analyses of the association between diastolic blood pressure and cardiovascular events: the J-curve revisited. Circulation 143, 895–906 (2021).

    Article  PubMed  Google Scholar 

  8. Rapsomaniki, E. et al. Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1.25 million people. Lancet 383, 1899–1911 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  9. Malik, R. et al. Relationship between blood pressure and incident cardiovascular disease: linear and nonlinear mendelian randomization analyses. Hypertension 77, 2004–2013 (2021).

    Article  CAS  PubMed  Google Scholar 

  10. Williams, B. et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur. Heart J. 39, 3021–3104 (2018).

    Article  PubMed  Google Scholar 

  11. Appel, L. J. et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH collaborative research group. N. Engl. J. Med. 336, 1117–1124 (1997).

    Article  CAS  PubMed  Google Scholar 

  12. Toledo, E. et al. Effect of the Mediterranean diet on blood pressure in the PREDIMED trial: results from a randomized controlled trial. BMC Med. 11, 207 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  13. Thomopoulos, C., Parati, G. & Zanchetti, A. Effects of blood pressure lowering on outcome incidence in hypertension: 7. Effects of more vs. less intensive blood pressure lowering and different achieved blood pressure levels — updated overview and meta-analyses of randomized trials. J. Hypertens. 34, 613–622 (2016).

    Article  CAS  PubMed  Google Scholar 

  14. Blood Pressure Lowering Treatment Trialists’ Collaboration. Blood pressure-lowering treatment based on cardiovascular risk: a meta-analysis of individual patient data. Lancet 384, 591–598 (2014).

    Article  Google Scholar 

  15. Thomopoulos, C., Parati, G. & Zanchetti, A. Effects of blood pressure lowering on outcome incidence in hypertension: 3. Effects in patients at different levels of cardiovascular risk-overview and meta-analyses of randomized trials. J. Hypertens. 32, 2305–2314 (2014).

    Article  CAS  PubMed  Google Scholar 

  16. Stergiou, G. S. et al. European society of hypertension recommendations for the validation of cuffless blood pressure measuring devices: European society of hypertension working group on blood pressure monitoring and cardiovascular variability. J. Hypertens. 41, 2074–2087 (2023).

    Article  CAS  PubMed  Google Scholar 

  17. Crump, C. et al. Adverse pregnancy outcomes and long term risk of ischemic heart disease in mothers: national cohort and co-sibling study. BMJ 380, e072112 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  18. Monticone, S. et al. Prevalence and clinical manifestations of primary aldosteronism encountered in primary care practice. J. Am. Coll. Cardiol. 69, 1811–1820 (2017).

    Article  PubMed  Google Scholar 

  19. Rossi, G. P. Primary aldosteronism: JACC state-of-the-art review. J. Am. Coll. Cardiol. 74, 2799–2811 (2019).

    Article  CAS  PubMed  Google Scholar 

  20. Mulatero, P. et al. Genetics, prevalence, screening and confirmation of primary aldosteronism: a position statement and consensus of the Working Group on Endocrine Hypertension of The European Society of Hypertension. J. Hypertens. 38, 1919–1928 (2020).

    Article  CAS  PubMed  Google Scholar 

  21. Mulatero, P. et al. Subtype diagnosis, treatment, complications and outcomes of primary aldosteronism and future direction of research: a position statement and consensus of the Working Group on Endocrine Hypertension of the European Society of Hypertension. J. Hypertens. 38, 1929–1936 (2020).

    Article  CAS  PubMed  Google Scholar 

  22. Sprint Research Group. A Randomized trial of intensive versus standard blood-pressure control. N. Engl. J. Med. 373, 2103–2116 (2015).

    Article  Google Scholar 

  23. ACCORD Study Group. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N. Engl. J. Med. 362, 1575–1585 (2010).

    Article  Google Scholar 

  24. Liu, J. et al. Lowering systolic blood pressure to less than 120 mm Hg versus less than 140 mm Hg in patients with high cardiovascular risk with and without diabetes or previous stroke: an open-label, blinded-outcome, randomised trial. Lancet 404, 245–255 (2024).

    Article  PubMed  Google Scholar 

  25. Blood Pressure Lowering Treatment Trialists’ Collaboration. Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis. Lancet 397, 1625–1636 (2021).

    Article  Google Scholar 

  26. Kannel, W. B. Risk stratification in hypertension: new insights from the Framingham study. Am. J. Hypertens. 13, 3S–10S (2000).

    Article  CAS  PubMed  Google Scholar 

  27. Weycker, D. et al. Risk-factor clustering and cardiovascular disease risk in hypertensive patients. Am. J. Hypertens. 20, 599–607 (2007).

    Article  PubMed  Google Scholar 

  28. Klooster, C. C. V. et al. Predicting 10-year risk of recurrent cardiovascular events andcardiovascular interventions in patients with established cardiovascular disease: results from UCC-SMART and REACH. Int. J. Cardiol. 325, 140–148 (2021).

    Article  PubMed  Google Scholar 

  29. Kaasenbrood, L. et al. Distribution of estimated 10-year risk of recurrent vascular events and residual risk in a secondary prevention population. Circulation 134, 1419–1429 (2016).

    Article  PubMed  Google Scholar 

  30. Taylor, C. J., Roalfe, A. K., Iles, R. & Hobbs, F. D. Ten-year prognosis of heart failure in the community: follow-up data from the Echocardiographic Heart of England Screening (ECHOES) study. Eur. J. Heart Fail. 14, 176–184 (2012).

    Article  PubMed  Google Scholar 

  31. Shah, K. S. et al. Heart failure with preserved, borderline, and reduced ejection fraction: 5-year outcomes. J. Am. Coll. Cardiol. 70, 2476–2486 (2017).

    Article  PubMed  Google Scholar 

  32. Benjamin, E. J. et al. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation 98, 946–952 (1998).

    Article  CAS  PubMed  Google Scholar 

  33. Mulnier, H. E. et al. Risk of myocardial infarction in men and women with type 2 diabetes in the UK: a cohort study using the general practice research database. Diabetologia 51, 1639–1645 (2008).

    Article  CAS  PubMed  Google Scholar 

  34. Soedamah-Muthu, S. S. et al. High risk of cardiovascular disease in patients with type 1 diabetes in the U.K.: a cohort study using the general practice research database. Diabetes Care 29, 798–804 (2006).

    Article  PubMed  Google Scholar 

  35. Paquette, M. et al. Familial hypercholesterolemia-risk-score: a new score predicting cardiovascular events and cardiovascular mortality in familial hypercholesterolemia. Arterioscler. Thromb. Vasc. Biol. 41, 2632–2640 (2021).

    Article  CAS  PubMed  Google Scholar 

  36. Vasan, R. S. et al. Hypertension-mediated organ damage: prevalence, correlates, and prognosis in the community. Hypertension 79, 505–515 (2022).

    Article  CAS  PubMed  Google Scholar 

  37. Patel, A. P., Wang, M., Kartoun, U., Ng, K. & Khera, A. V. Quantifying and understanding the higher risk of atherosclerotic cardiovascular disease among south asian individuals: results from the UK biobank prospective cohort study. Circulation 144, 410–422 (2021).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Veronesi, G. et al. Improving long-term prediction of first cardiovascular event: the contribution of family history of coronary heart disease and social status. Prev. Med. 64, 75–80 (2014).

    Article  CAS  PubMed  Google Scholar 

  39. Kimenai, D. M. et al. Socioeconomic deprivation: an important, largely unrecognized risk factor in primary prevention of cardiovascular disease. Circulation 146, 240–248 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  40. Conrad, N. et al. Autoimmune diseases and cardiovascular risk: a population-based study on 19 autoimmune diseases and 12 cardiovascular diseases in 22 million individuals in the UK. Lancet 400, 733–743 (2022).

    Article  PubMed  Google Scholar 

  41. Correll, C. U. et al. Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: a large-scale meta-analysis of 3,211,768 patients and 113,383,368 controls. World Psychiatry 16, 163–180 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  42. Shah, A. S. V. et al. Global burden of atherosclerotic cardiovascular disease in people living with HIV: systematic review and meta-analysis. Circulation 138, 1100–1112 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  43. Honigberg, M. C. et al. Long-term cardiovascular risk in women with hypertension during pregnancy. J. Am. Coll. Cardiol. 74, 2743–2754 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  44. Kramer, C. K., Campbell, S. & Retnakaran, R. Gestational diabetes and the risk of cardiovascular disease in women: a systematic review and meta-analysis. Diabetologia 62, 905–914 (2019).

    Article  PubMed  Google Scholar 

  45. Kyriacou, H. et al. The risk of cardiovascular diseases after miscarriage, stillbirth, and induced abortion: a systematic review and meta-analysis. Eur. Heart J. Open 2, oeac065 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  46. Lonn, E. M. et al. Blood-pressure lowering in intermediate-risk persons without cardiovascular disease. N. Engl. J. Med. 374, 2009–2020 (2016).

    Article  CAS  PubMed  Google Scholar 

  47. Bosch, J. et al. Lowering cholesterol, blood pressure, or both to prevent cardiovascular events: results of 8.7 years of follow-up of heart outcomes evaluation prevention (HOPE)-3 study participants. Eur. Heart J. 42, 2995–3007 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  48. Brunström, M., Thomopoulos, C., Carlberg, B., Kreutz, R. & Mancia, G. Methodological aspects of meta-analyses assessing the effect of blood pressure-lowering treatment on clinical outcomes. Hypertension 79, 491–504 (2022).

    Article  PubMed  Google Scholar 

  49. Kjeldsen, S. E. et al. Should treatment of ‘elevated’ blood pressure, especially in older people, be based on global risk estimation? Blood Press. 33, 2430228 (2024).

    Article  PubMed  Google Scholar 

  50. Sundström, J. et al. Effects of blood pressure reduction in mild hypertension: a systematic review and meta-analysis. Ann. Intern. Med. 162, 184–191 (2015).

    Article  PubMed  Google Scholar 

  51. Ettehad, D. et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet 387, 957–967 (2016).

    Article  PubMed  Google Scholar 

  52. Bidel, Z. et al. Sex-specific effects of blood pressure lowering pharmacotherapy for the prevention of cardiovascular disease: an individual participant-level data meta-analysis. Hypertension 80, 2293–2302 (2023).

    Article  CAS  PubMed  Google Scholar 

  53. Ji, H. et al. Sex differences in blood pressure associations with cardiovascular outcomes. Circulation 143, 761–763 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  54. Kringeland, E. et al. Stage 1 hypertension, sex, and acute coronary syndromes during midlife: the Hordaland health study. Eur. J. Prev. Cardiol. 29, 147–154 (2022).

    Article  PubMed  Google Scholar 

  55. SCORE2 working group and ESC Cardiovascular risk collaboration. SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe. Eur. Heart J. 42, 2439–2454 (2021).

    Article  Google Scholar 

  56. SCORE2-OP working group and ESC Cardiovascular risk collaboration. SCORE2-OP risk prediction algorithms: estimating incident cardiovascular event risk in older persons in four geographical risk regions. Eur. Heart J. 42, 2455–2467 (2021).

    Article  Google Scholar 

  57. Barozet, M., Le Tilly, O., Bejan-Angoulvant, T., Fesler, P. & Roubille, C. Hypertension and cardiovascular outcomes in inflammatory and autoimmune diseases: a systematic review and meta-analysis. Curr. Hypertens. Rep. 26, 419–429 (2024).

    Article  PubMed  Google Scholar 

  58. Haug, E. B. et al. Association of conventional cardiovascular risk factors with cardiovascular disease after hypertensive disorders of pregnancy: analysis of the Nord-Trondelag health study. JAMA Cardiol. 4, 628–635 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  59. Sarwal, A. et al. Baseline diastolic BP and BP-lowering effects on cardiovascular outcomes and all-cause mortality: a meta-analysis. J. Am. Soc. Nephrol. 36, 911–922 (2024).

    Article  PubMed  Google Scholar 

  60. Rao, S. et al. Systolic blood pressure and cardiovascular risk in patients with diabetes: a prospective cohort study. Hypertension 80, 598–607 (2023).

    Article  CAS  PubMed  Google Scholar 

  61. Zhang, W. et al. Trial of intensive blood-pressure control in older patients with hypertension. N. Engl. J. Med. 385, 1268–1279 (2021).

    Article  CAS  PubMed  Google Scholar 

  62. Verdecchia, P. et al. Usual versus tight control of systolic blood pressure in non-diabetic patients with hypertension (Cardio-Sis): an open-label randomised trial. Lancet 374, 525–533 (2009).

    Article  PubMed  Google Scholar 

  63. SPS3 Study Group. Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial. Lancet 382, 507–515 (2013).

    Article  Google Scholar 

  64. SPRINT Research Group. Final report of a trial of intensive versus standard blood-pressure control. N. Engl. J. Med. 384, 1921–1930 (2021).

    Article  Google Scholar 

  65. Blood Pressure Lowering Treatment Trialists’ Collaboration. Age-stratified and blood-pressure-stratified effects of blood-pressure-lowering pharmacotherapy for the prevention of cardiovascular disease and death: an individual participant-level data meta-analysis. Lancet 398, 1053–1064 (2021).

    Article  Google Scholar 

  66. Whelton, P. K., O’Connell, S., Mills, K. T. & He, J. Optimal antihypertensive systolic blood pressure: a systematic review and meta-analysis. Hypertension 81, 2329–2339 (2024).

    Article  CAS  PubMed  Google Scholar 

  67. He, J. et al. Effectiveness of a non-physician community health-care provider-led intensive blood pressure intervention versus usual care on cardiovascular disease (CRHCP): an open-label, blinded-endpoint, cluster-randomised trial. Lancet 401, 928–938 (2023).

    Article  PubMed  Google Scholar 

  68. Bi, Y. et al. Intensive blood-pressure control in patients with type 2 diabetes. N. Engl. J. Med. 392, 1155–1167 (2025).

    Article  CAS  PubMed  Google Scholar 

  69. Beckett, N. S. et al. Treatment of hypertension in patients 80 years of age or older. N. Engl. J. Med. 358, 1887–1898 (2008).

    Article  CAS  PubMed  Google Scholar 

  70. Williamson, J. D. et al. Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged ≥75 years: a randomized clinical trial. JAMA 315, 2673–2682 (2016).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  71. Wang, Z. et al. The effect of frailty on the efficacy and safety of intensive blood pressure control: a post hoc analysis of the SPRINT trial. Circulation 148, 565–574 (2023).

    Article  CAS  PubMed  Google Scholar 

  72. Parving, H. H. et al. Cardiorenal end points in a trial of aliskiren for type 2 diabetes. N. Engl. J. Med. 367, 2204–2213 (2012).

    Article  CAS  PubMed  Google Scholar 

  73. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). JAMA 288, 2981–2997 (2002).

    Article  Google Scholar 

  74. Wald, D. S., Law, M., Morris, J. K., Bestwick, J. P. & Wald, N. J. Combination therapy versus monotherapy in reducing blood pressure: meta-analysis on 11,000 participants from 42 trials. Am. J. Med. 122, 290–300 (2009).

    Article  PubMed  Google Scholar 

  75. MacDonald, T. M. et al. Combination therapy is superior to sequential monotherapy for the initial treatment of hypertension: a double-blind randomized controlled trial. J. Am. Heart Assoc. 6, e006986 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  76. Webster, R. et al. Fixed low-dose triple combination antihypertensive medication vs usual care for blood pressure control in patients with mild to moderate hypertension in Sri Lanka: a randomized clinical trial. JAMA 320, 566–579 (2018).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  77. Chow, C. K. et al. Initial treatment with a single pill containing quadruple combination of quarter doses of blood pressure medicines versus standard dose monotherapy in patients with hypertension (QUARTET): a phase 3, randomised, double-blind, active-controlled trial. Lancet 398, 1043–1052 (2021).

    Article  PubMed  Google Scholar 

  78. Rea, F., Corrao, G., Merlino, L. & Mancia, G. Initial antihypertensive treatment strategies and therapeutic inertia. Hypertension 72, 846–853 (2018).

    Article  CAS  PubMed  Google Scholar 

  79. Parati, G., Kjeldsen, S., Coca, A., Cushman, W. C. & Wang, J. Adherence to single-pill versus free-equivalent combination therapy in hypertension: a systematic review and meta-analysis. Hypertension 77, 692–705 (2021).

    Article  CAS  PubMed  Google Scholar 

  80. Mancia, G., Zambon, A., Soranna, D., Merlino, L. & Corrao, G. Factors involved in the discontinuation of antihypertensive drug therapy: an analysis from real life data. J. Hypertens. 32, 1708–1715 (2014).

    Article  CAS  PubMed  Google Scholar 

  81. Thomopoulos, C., Bazoukis, G., Tsioufis, C. & Mancia, G. Beta-blockers in hypertension: overview and meta-analysis of randomized outcome trials. J. Hypertens. 38, 1669–1681 (2020).

    Article  CAS  PubMed  Google Scholar 

  82. Thomopoulos, C., Parati, G. & Zanchetti, A. Effects of blood pressure-lowering on outcome incidence in hypertension: 5. Head-to-head comparisons of various classes of antihypertensive drugs - overview and meta-analyses. J. Hypertens. 33, 1321–1341 (2015).

    Article  CAS  PubMed  Google Scholar 

  83. Wei, J. et al. Comparison of cardiovascular events among users of different classes of antihypertension medications: a systematic review and network meta-analysis. JAMA Netw. Open 3, e1921618 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  84. Thomopoulos, C., Parati, G. & Zanchetti, A. Effects of blood pressure lowering on outcome incidence in hypertension: 4. Effects of various classes of antihypertensive drugs-overview and meta-analyses. J. Hypertens. 33, 195–211 (2015).

    Article  CAS  PubMed  Google Scholar 

  85. Law, M. R., Morris, J. K. & Wald, N. J. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ 338, b1665 (2009).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  86. Messerli, F. H., Suter, T. & Bangalore, S. What ever happened to cardioprotection with beta-blockers? Mayo Clin. Proc. 93, 401–403 (2018).

    Article  PubMed  Google Scholar 

  87. Corrao, G. et al. Discontinuation of and changes in drug therapy for hypertension among newly-treated patients: a population-based study in Italy. J. Hypertens. 26, 819–824 (2008).

    Article  CAS  PubMed  Google Scholar 

  88. do Vale, G. T., Ceron, C. S., Gonzaga, N. A., Simplicio, J. A. & Padovan, J. C. Three generations of beta-blockers: history, class differences and clinical applicability. Curr. Hypertens. Rev. 15, 22–31 (2019).

    Article  PubMed  Google Scholar 

  89. Viigimaa, M. et al. Update of the position paper on arterial hypertension and erectile dysfunction. J. Hypertens. 38, 1220–1234 (2020).

    Article  CAS  PubMed  Google Scholar 

  90. Mackenzie, I. S. et al. Cardiovascular outcomes in adults with hypertension with evening versus morning dosing of usual antihypertensives in the UK (TIME study): a prospective, randomised, open-label, blinded-endpoint clinical trial. Lancet 400, 1417–1425 (2022).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  91. Williams, B. et al. Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomised, double-blind, crossover trial. Lancet 386, 2059–2068 (2015).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  92. Krieger, E. M. et al. Spironolactone versus clonidine as a fourth-drug therapy for resistant hypertension: the ReHOT randomized study (resistant hypertension optimal treatment). Hypertension 71, 681–690 (2018).

    Article  CAS  PubMed  Google Scholar 

  93. Tam, T. S. et al. Eplerenone for hypertension. Cochrane Database Syst. Rev. 2, CD008996 (2017).

    PubMed  Google Scholar 

  94. Lauder, L., Kandzari, D. E., Lüscher, T. F. & Mahfoud, F. Renal denervation in the management of hypertension. EuroIntervention 20, e467–e478 (2024).

    Article  PubMed  PubMed Central  Google Scholar 

  95. Barbato, E. et al. Renal denervation in the management of hypertension in adults. A clinical consensus statement of the ESC council on hypertension and the European association of percutaneous cardiovascular interventions (EAPCI). Eur. Heart J. 44, 1313–1330 (2023).

    Article  CAS  PubMed  Google Scholar 

  96. Vukadinovic, D. et al. Effects of catheter-based renal denervation in hypertension: a systematic review and meta-analysis. Circulation 150, 1599–1611 (2024).

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

M.B. is supported by the Deutsche Forschungsgemeinschaft (German Research Foundation) (TTR 219, project number 322900939). A.E.S. is funded by the National Health and Medical Research Council of Australia (APP APP2017504). B.W. is funded in part by the NIHR University College London Hospitals Biomedical Research Centre. R.M.T. is funded by the Canadian Institutes of Health Research, the Canada Foundation for Innovation and the Leducq Foundation. F.M. has been supported by Deutsche Forschungsgemeinschaft (SFB TRR219, project number 322900939) and Deutsche Herzstiftung.

Author information

Author notes

  1. These authors contributed equally: Lucas Lauder, Thomas Weber.

  2. These authors jointly supervised this work: Rhian M. Touyz, Felix Mahfoud.

Authors and Affiliations

  1. Department of Cardiology, University Heart Center, University Hospital Basel, Basel, Switzerland

    Lucas Lauder & Felix Mahfoud

  2. Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland

    Lucas Lauder & Felix Mahfoud

  3. Department of Internal Medicine II, Cardiology and Intensive Care Medicine, Klinikum Wels-Grieskirchen, Wels, Austria

    Thomas Weber

  4. HOMICAREM (Homburg Institute for CardioRenalMetabolic Medicine) and Klinik für Innere Medizin III, Saarland University, Homburg, Germany

    Michael Böhm

  5. Department of Cardiology, Cardiovascular Center Aalst, AZORG Clinic Aalst, Aalst, Belgium

    Sofie Brouwers

  6. Department of Experimental Pharmacology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium

    Sofie Brouwers

  7. Université Paris Cité, Inserm, PARCC, Paris, France

    Rosa Maria Bruno

  8. Pharmacology and Hypertension Unit, AP-HP, Hôpital Européen Georges Pompidou, Paris, France

    Rosa Maria Bruno

  9. Department of Clinical Science, University of Bergen, Bergen, Norway

    Eva Gerdts

  10. Department of Heart Disease, Haukeland University Hospital, Bergen, Norway

    Eva Gerdts

  11. Institute of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany

    Reinhold Kreutz

  12. Heart Division, Royal Brompton & Harefield Hospitals GSTT and Cardiovascular Academic Group, King’s College, London, UK

    Thomas F. Lüscher

  13. Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland

    Thomas F. Lüscher

  14. University of Milano-Bicocca, Milan, Italy

    Giuseppe Mancia

  15. National Institute for Prevention and Cardiovascular Health and University of Galway School of Medicine, Galway, Ireland

    John William McEvoy

  16. Brighton and Sussex Medical School, Universities of Brighton and of Sussex, Brighton, UK

    Richard J. McManus

  17. The Cardiac Clinic Groote Schuur Hospital and Division of Cardiology, Faculty of Health Sciences University of Cape Town, Cape Town, South Africa

    Mpiko Ntsekhe

  18. Department of Cardiology, IRCCS San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy

    Gianfranco Parati

  19. Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy

    Gianfranco Parati

  20. National Institute of Cardiology, Cardiovascular Surgery and Interventional Cardiology (INCCI), Luxembourg City, Luxembourg

    Atul Pathak

  21. Primary Care Unit, Unidade Local de Saúde de Entre Douro e Vouga, São João da Madeira, Portugal

    Rosa de Pinho

  22. Deep Medicine, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK

    Kazem Rahimi

  23. 1st Department of Nephrology, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece

    Pantelis Sarafidis

  24. School of Population Health, University of New South Wales, Sydney, New South Wales, Australia

    Aletta E. Schutte

  25. The George Institute for Global Health, Sydney, New South Wales, Australia

    Aletta E. Schutte

  26. University College London, London, UK

    Bryan Williams

  27. Research Institute of McGill University Health Centre, McGill University, Montreal, Quebec, Canada

    Rhian M. Touyz

Authors
  1. Lucas Lauder
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  2. Thomas Weber
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  3. Michael Böhm
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  4. Sofie Brouwers
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  5. Rosa Maria Bruno
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  6. Eva Gerdts
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  7. Reinhold Kreutz
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  8. Thomas F. Lüscher
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  9. Giuseppe Mancia
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  10. John William McEvoy
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  11. Richard J. McManus
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  12. Mpiko Ntsekhe
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  13. Gianfranco Parati
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  14. Atul Pathak
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  15. Rosa de Pinho
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  16. Kazem Rahimi
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  17. Pantelis Sarafidis
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  18. Aletta E. Schutte
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  19. Bryan Williams
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  20. Rhian M. Touyz
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  21. Felix Mahfoud
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Contributions

The authors contributed substantially to all aspects of the manuscript.

Corresponding authors

Correspondence to Lucas Lauder or Felix Mahfoud.

Ethics declarations

Competing interests

L.L. has received speaker honoraria from AstraZeneca, Medtronic, Pfizer and Recor Medical, and advisory fees from Medtronic and Recor Medical. T.W. has received speaker honoraria and advisory fees from AstraZeneca, Bayer, BMS, Boehringer Ingelheim, Gedeon Richter, Medtronic, Menarini, Merck, Pfizer, Recor and Servier. M.B. has received personal fees from Abbott, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Cytokinetics, Medtronic, Novartis, Recor, Servier and Vifor. S.B. reports speaker/consulting fees to the department from Amgen, Daiichi Sankyo, Medtronic, Merck, Novartis, Recor Medical, Sanofi and Servier. R.M.B. reports speaker honoraria from El Kendi and Servier, and has received devices on free loan from Quipu, Unex and Visualsonics-Fujifilm. E.G. has received honoraria for a lecture at a seminar from Amgen and Boehringer Ingelheim. R.K. has received honoraria for consultancy, lectures and support for research from AstraZeneca, Bayer, Krka, Menarini Group, Merck, PolPharma, ProMed, Recor, Sanofi and Servier. G.M. has received compensation as a speaker, chairman and/or consultant from Berlin Chemie, IPCA Laboratories, Medtronic, Menarini, Merck Healthcare, Omnicuris, Recordati, Sanofi, Servier and Sun Laboratories. R.J.M. has received institutional payments for licensing and consulting from Omron concerning a telemonitoring system. G.P. has received speaker honoraria from Merck, Omron, Somnomedics and Viatris. R.d.P. has received speaker honoraria from Merck, Servier and Tecnimede. K.R. has received honoraria to his institution for an advisory role to Medtronic, and has received funding for research from the European Union, Medical Research Council, Novo Nordisk, Roche and UK Research and Innovation. P.S. has received advisory honoraria from Astellas, AstraZeneca, Baxter, Bayer, Boehringer Ingelheim, Healthink, Menarini, Primeview and Recor Medical, and has received speaker honoraria from AICME, Astellas, AstraZeneca, Bayer, Boehringer Ingelheim, Genesis Pharma, Menarini, Peervoice, Science Collected, Springer and WebMD, and has received institutional research support from Boehringer Ingelheim, Genesis Pharma, Menarini and Vianex. A.E.S. has received speaker honoraria from Abbott, Aktiia, AstraZeneca, Medtronic, Omron, Sanofi and Servier, and serves on scientific advisory boards for Medtronic, SiSU Health and Sky Labs. B.W. is the Chief Scientific and Medical Officer at the British Heart Foundation, chairs and/or serves on the scientific steering committees of clinical trials of currently unlicensed new medicines supported by Alnylam, AstraZeneca and Novartis, and has provided scientific advice to Anlia and Eli Lilly. F.M. has received speaker honoraria/consulting fees from Ablative Solutions, AstraZeneca, Inari, Medtronic, Merck, Novartis, Philips and Recor Medical, and Saarland University has received scientific support from Ablative Solutions, Medtronic and Recor Medical. The other authors declare no competing interests.

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Lauder, L., Weber, T., Böhm, M. et al. European guidelines for hypertension in 2024: a comparison of key recommendations for clinical practice. Nat Rev Cardiol 22, 675–688 (2025). https://doi.org/10.1038/s41569-025-01187-2

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