A consensus statement from the Portuguese Society of Hypertension and the Portuguese Society of Cardiology for bridging the 2023-2025 hypertension Guidelines in clinical practice.

BACKGROUND

Effective management of arterial hypertension remains a major global health priority. In the need to improve real-world implementation of best practices, three international organisations have released independent clinical practice guidelines: the European Society of Hypertension (ESH, 2023), the European Society of Cardiology (ESC, 2024) and the American College of Cardiology/American Heart Association (AHA/ACC, 2025).1.

AIM AND

METHODS

This society-endorsed consensus document, jointly developed by the Portuguese Society of Hypertension and the Portuguese Society of Cardiology, aims to harmonise partially divergent hypertension guidelines into applicable recommendations. It provides a pragmatic comparative synthesis of the 2023-2025 guidelines, structured according to the M.A.P.E. framework (Measure, Assess, Prescribe, Evaluate), to support decision-making in clinical practice.

RESULTS

Across European guidelines, there is a strong alignment in the definition of hypertension (systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg), CV risk stratification, lifestyle interventions, and first-line use of combination therapy of two drugs out of four. Divergences arise in BP classification systems, initiation thresholds, dosing strategies and target BP goals. The 2025 AHA/ACC Guidelines differ by adopting lower diagnostic and treatment thresholds (≥130/80 mmHg) and early pharmacological intervention based on individual CV risk. This consensus acknowledges differences and supports a risk-based approach grounded in randomised trial evidence, feasibility in routine clinical practice, and patient safety, recognising office BP as the basis for treatment decisions.

CONCLUSIONS

This consensus aims to reduce clinical uncertainty and optimise hypertension management in real-world practice providing clear and evidence-informed clinical recommendations.