[Management of elevated blood pressure and hypertension : Focus on risk reduction].

The 2024 hypertension guidelines from the European Society of Cardiology (ESC) introduce the category of 'elevated blood pressure' (120-139/70-89 mm Hg) and emphasise the importance of early prevention in individuals with such blood pressure levels and comorbid conditions. As blood pressure is recognised as a continuous risk factor, early initiation of antihypertensive treatment may be recommended even below the hypertensive range, depending on overall cardiovascular risk. All affected individuals should adopt a healthy lifestyle: regular exercise, balanced diet, reduced alcohol and salt intake, weight loss, and smoking cessation. If blood pressure remains > 130/80 mm Hg after three months and the patient has cardiovascular disease, heart failure, or a moderate to high risk, pharmacotherapy is advised. At ≥ 140/90 mm Hg, lifestyle measures and low-dose dual combination therapy should be initiated concurrently. The target systolic blood pressure is 120-129 mm Hg, with exceptions for individuals with frailty or those aged > 85 years. For resistant hypertension, spironolactone is the recommended pharmacological therapy, while renal denervation is listed as an interventional option.