Reclassification of office blood pressure categories according to the 2024 European Society of Cardiology guidelines and its implications for clinical practice in primary care: a cross-sectional study

BACKGROUND: The 2024 European Society of Cardiology (ESC) guidelines retained the diagnostic threshold for hypertension (≥ 140/90 mmHg) but revised the classification of office blood pressure (BP) values below this threshold and introduced a risk-based management strategy. However, there are limited data regarding the impact of these changes on primary care practice. AIM: The aim of this study was to evaluate the reclassification of office BP categories among primary care patients according to the 2024 ESC guidelines for elevated BP and hypertension, and to assess achievement of target BP based on these revised targets. METHODS: This retrospective cross-sectional study included 882 individuals aged 18 years or older registered at a family health center (FHC) in Izmir. Participants were classified according to the 2018 ESC/European Society of Hypertension (ESH) and 2024 ESC criteria. Cardiovascular risk was determined using the Systematic Coronary Risk Evaluation 2 (SCORE2) and SCORE2-Older Persons (SCORE2-OP) algorithms. The primary endpoint was the change in office BP classification, and the secondary endpoint was the proportion of patients achieving the BP target. RESULTS: Overall, 29.5% of the participants had hypertension. Under the 2018 ESC/ESH guidelines, 70.5% of individuals had optimal, normal, or high-normal office BP, whereas under the 2024 ESC guidelines, only 17.1% had non-elevated BP. Applying the 2024 criteria, 53.4% of all participants were placed in the elevated BP group, with 75.7% of individuals previously considered below the hypertension threshold reclassified into this group. The proportion of treated patients achieving the prespecified BP target decreased from 53.5% under the 2018 ESC/ESH criteria to 30.8% under the 2024 ESC framework. CONCLUSION: Applying the 2024 ESC office BP criteria reclassified more than half of our participants into the newly defined "elevated BP" group. This update could influence daily clinical practice by changing how clinicians determine which patients require closer assessment, ongoing follow-up, and treatment to achieve target BP.