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March 19, 2026Exploration of MedicineOpen Access

Treatment of hypertension in Norway in relation to new European hypertension guidelines

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Why the study?

New ESC guidelines recommend pharmacotherapy for BP > 130/80 mmHg if estimated 10-year cardiovascular risk exceeds 10% regardless of age, but the evidence base and clinical implications of these recommendations required critical evaluation.

Design

Editorial

Key result

The 2024 ESC guidelines recommending pharmacological treatment for elevated blood pressure (120-139/70-89 mmHg) at a fixed 10% cardiovascular risk threshold lack direct randomized trial evidence.

Authors

SKSverre E. KjeldsenBGBjørn GjelsvikTKTor Ole Klemsdal

Discussion

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Overview

Clinicians should retain age-adjusted national BP thresholds; challenges ESC recommendations for pharmacotherapy at 10% CV risk.

Key Points

  • The aim is to assess the appropriateness of new European hypertension guidelines in the context of Norway's healthcare system.
  • Analysis of European Society of Cardiology hypertension guidelines.
  • Comparison with Norwegian National Directorate of Health's recommendations.
  • Critique of risk estimation methods in meta-analyses.
  • The new guidelines may unfairly prolong treatment for younger individuals with elevated BP.
  • Fixed risk thresholds without age consideration could misguide treatment for older patients.
  • Argument against implementing these guidelines in Norway due to lack of evidence.

PICO

P
Population
Hypertension
I
Intervention / Comparator
Pharmacological antihypertensive treatment

The 2024 ESC hypertension guidelines recommending treatment for elevated BP based on a 10% risk threshold are not evidence-based and should not replace age-adjusted national guidelines in Norway.

Limitations

  • The meta-analyses supporting the ESC guidelines included patients with established hypertension and cardiovascular risk conditions, lacking direct relevance to healthy individuals with elevated BP.
  • Risk levels in the supporting meta-analysis were estimated through post hoc analysis rather than a priori with the recommended SCORE2 risk tool.
  • A fixed 10% risk threshold regardless of age disproportionately qualifies older individuals for treatment while potentially delaying treatment for younger individuals with early-onset high BP.

Cite This Study

Kjeldsen et al. (2026) conducted a review in Hypertension. Pharmacological antihypertensive treatment was evaluated. The 2024 ESC guidelines recommending pharmacological treatment for elevated blood pressure (120-139/70-89 mmHg) at a fixed 10% cardiovascular risk threshold lack direct randomized trial evidence.

synapsesocial.com/papers/69bb92f2496e729e62980b76https://doi.org/10.37349/emed.2026.1001390
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