Targets for Treatment and Optimal Strategies for Non-Pharmacological and Pharmacological Management of Hypertension

Recent hypertension guidelines differ in their recommendations on managing hypertension and associated cardiovascular risk. In this review, we highlight the key similarities and discrepancies among the recently published American College of Cardiology (ACC)/American Heart Association (AHA), European Society of Cardiology (ESC), and European and International Society of Hypertension (ESH/ISH) blood pressure (BP) guidelines. Despite differences in the definition of hypertension, all guidelines reflect a general trend toward earlier intervention and more stringent BP targets, particularly for individuals at high cardiovascular risk. They align on lifestyle recommendations, such as dietary modification and physical activity, and advocate for combination therapy with a target BP of <130/80 mmHg if the risk is sufficiently high and treatment well tolerated. However, notable differences exist in treatment thresholds and BP targets for elderly individuals, as well as in the classification of hypertension phenotypes in younger patients. There are few discrepancies in recommended treatment classes, with all guidelines endorsing ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, and thiazide-type diuretics as first-line therapy. Knowledge gaps remain regarding optimal BP thresholds and targets across sex, age, and ethnic groups. Additional uncertainties include the clinical utility of intermediate outcomes in cardiovascular risk assessment, the long-term impact of lifecourse approaches to prevention, and the role of novel therapeutic agents. Emerging concerns such as climate change and air pollution also warrant further investigation for their potential effects on hypertension and cardiovascular risk.