BACKGROUND: Health literacy (HL) is considered as one of the most important approaches for individual, societal, and systemic behaviour changes that promote drug adherence. This study conducted to examined the associatio...BACKGROUND: Health literacy (HL) is considered as one of the most important approaches for individual, societal, and systemic behaviour changes that promote drug adherence. This study conducted to examined the association between health literacy and medication adherence among hypertension patients. METHODS: A cross-sectional design was utilised among 175 hypertensive patients from three public hospitals. The data collection was done for a duration of six weeks between February and March 2025, by using two tools High Blood Pressure Health Literacy Scale (HBP-HLS) and the Medication Adherence Report Scale (MARS-5), self-reported methods. Descriptive statistics, Pearson's correlation coefficients, and multiple linear regression were performed. RESULTS: The majority of the respondents were female ( = 100, 57.1%), with mean age was 58.4 years. The mean blood pressure readings of 142.3/87.1 mmHg. The mean total score was 22.56 (SD = 3.12) out of a possible 25, indicating a relatively high average level of self-reported adherence. In terms of total health literacy, participants had a mean total score of 30.76 out of 43 (SD = 6.42). A statistically significant with positive correlation between health literacy and medication adherence ( = 0.28, < 0.01). Comorbidities, number of medications, educational level, income, and BMI were strong independent predictor for health literacy. CONCLUSION: Policymakers are advised to prioritise health literacy improving interventions through tailored education, simplified treatment regimens, and community-based support systems to promote sustainable, equitable hypertension care across diverse populations.
OBJECTIVE: To explore perceptions, behaviours and barriers of pharmacists in the United Kingdom regarding medication adherence management in hypertension. METHODS: A cross-sectional online questionnaire, adapted from the...OBJECTIVE: To explore perceptions, behaviours and barriers of pharmacists in the United Kingdom regarding medication adherence management in hypertension. METHODS: A cross-sectional online questionnaire, adapted from the European Ascertaining Barriers for Compliance (ABC) project, was distributed to UK-registered pharmacists between January and June 2024. The survey included 19 questions across six domains: participant characteristics, beliefs, adherence assessment methods, interventions, barriers and training. Descriptive analysis was performed. RESULTS: Seventy-six pharmacists responded (53.9% male; 35.5% hospital, 31.6% primary care, 26.3% community). Nearly all (97.4%) agreed that patients' concerns affect adherence. Assessment relied mainly on asking about missed doses (60.5% frequently/always), while objective methods were rarely used, including chemical adherence testing (67.1% never), electronic monitoring (79.8%) and questionnaires (55.4%). Key barriers were high workload (56.6%), limited consultation time (52.6%) and poor interprofessional coordination (51.3%). Most respondents reported insufficient training: 77.3% wanted more undergraduate training and 60.5% had none post-registration; 86.7% did not use guideline recommendations. CONCLUSIONS: UK pharmacists recognise the importance of adherence but lack the time, tools and training to assess it systematically. Addressing system-level barriers and strengthening adherence education are essential to support their expanding role in hypertension management.
BACKGROUND: Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide, driven by multifactorial risk factors, including undiagnosed hypertension. Masked nocturnal hypertension (MNH), cha...BACKGROUND: Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide, driven by multifactorial risk factors, including undiagnosed hypertension. Masked nocturnal hypertension (MNH), characterised by elevated night-time BP despite normal daytime levels, has been linked to increased CVD risk and hypertensive target organ damage. This systematic review and meta-analysis aim to synthesise evidence on the relationship between MNH and CVD risk. METHODS: A comprehensive search was conducted in PubMed, Web of Science, and Embase for studies published until December 20, 2025. Observational studies reporting associations between MNH and CVD risk with sufficient statistical data for meta-analysis were included. The pooled Hazard ratio (HR) was calculated using a random effect model using R software version 4.4. Heterogeneity was assessed with I and sensitivity analyses were conducted to evaluate robustness. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). RESULTS: Out of 10,521 records screened, 5 studies with a sample size of over 19,000 participants were included. The studies consistently reported a significant association between elevated MNH levels and increased CVD risk. Meta-analysis yielded a pooled HR of 1.471 (95% CI: 1.008-2.147), confirming the association. No heterogeneity was observed (I = 0%). Sensitivity analysis demonstrated the robustness of the findings. CONCLUSION: This meta-analysis suggests a positive association between MNH and increased CVD risk, though the limited number of studies warrants caution in over-interpretation. While MNH appears to be a relevant phenotype for cardiovascular risk stratification, further large-scale prospective research is required to confirm the magnitude of this effect and its clinical utility in routine hypertension management.
OBJECTIVE: To investigate the effect of whole‑body vibration training (WBVT) on resting blood pressure (BP) in adults and its moderating factors through a meta‑analysis. METHODS: PubMed, Cochrane Library, Embase, and Web...OBJECTIVE: To investigate the effect of whole‑body vibration training (WBVT) on resting blood pressure (BP) in adults and its moderating factors through a meta‑analysis. METHODS: PubMed, Cochrane Library, Embase, and Web of Science were systematically searched up to 2 December 2025, with systolic BP (SBP) and diastolic BP (DBP) as the primary outcomes. Using Stata 17.0 software, effect sizes were pooled with a random‑effects model, and results were reported as weighted mean differences (WMDs) with 95% confidence intervals. RESULTS: This meta-analysis included 14 randomised controlled trials (RCTs) involving 490 adult participants. WBVT significantly reduced SBP (WMD = -6.57 mmHg, 95% CI [-8.84, -4.29]; < 0.01) and DBP (WMD = -3.01 mmHg, 95% CI [-4.32, -1.71]; < 0.01) in adults. Subgroup analyses showed greater BP reduction in individuals with higher baseline BP (SBP: -11.34 mmHg [95% CI: -13.45, -9.23]; < 0.01; DBP: -6.15 mmHg [95% CI: -7.46, -4.83]; < 0.01) and in those who were overweight or obese (SBP: -8.99 mmHg [95% CI: -11.18, -6.80]; < 0.01; DBP: -3.98 mmHg [95% CI: -5.17, -2.78]; < 0.01). Interventions using combined movement patterns also yielded more pronounced effects (SBP: -7.12 mmHg [95% CI: -9.73, -4.51]; < 0.01; DBP: -3.30 mmHg [95% CI: -5.61, -0.79]; < 0.01). CONCLUSION: WBVT significantly reduced resting BP in adults, particularly effective in those with higher baseline BP, overweight/obese, or using combined exercise protocols, but further high-quality RCTs are needed.
PURPOSE: This review summarizes current evidence on visit-to-visit blood pressure variability (BPV) and blood pressure time in target range (TTR) as complementary measures of blood pressure (BP) control, and to evaluate...PURPOSE: This review summarizes current evidence on visit-to-visit blood pressure variability (BPV) and blood pressure time in target range (TTR) as complementary measures of blood pressure (BP) control, and to evaluate their ability to predict cardiovascular (CV) risk beyond mean BP values in hypertensive populations. MATERIALS AND METHODS: We performed a narrative review of observational studies, post-hoc analyses of randomised clinical trials, and population-based cohorts evaluating long-term systolic BPV and TTR in relation to adverse CV outcomes. Evidence comparing BPV and TTR, including studies assessing their combined prognostic value, was synthesised to examine their relative and complementary roles in CV risk prediction beyond mean BP levels. RESULTS: Long-term systolic visit-to-visit BPV has been consistently associated with increased risks of CV morbidity, mortality, stroke, and cognitive decline, independent of mean BP. Similarly, higher systolic TTR has been associated with lower risks of all-cause mortality, CV events, heart failure, and composite CV outcomes across diverse populations and BP monitoring strategies. Studies evaluating both indices concurrently demonstrate that BPV and TTR provide independent and complementary prognostic information, with patients exhibiting low TTR and high BPV experiencing the highest CV risk. While TTR reflects the duration and stability of BP control within target ranges, BPV captures the magnitude of BP fluctuations, aspects not fully conveyed by average BP values alone. CONCLUSION: BPV and TTR represent complementary, clinically meaningful measures that improve CV risk stratification beyond mean BP. Their integration into routine hypertension management may enhance identification of residual risk, and support more individualized treatment strategies .
OBJECTIVE: This systematic review and meta-analysis evaluated the efficacy and safety of acupuncture for primary hypertension, based on randomised controlled trials (RCTs) published between 2015 and 2024. METHODS: We sea...OBJECTIVE: This systematic review and meta-analysis evaluated the efficacy and safety of acupuncture for primary hypertension, based on randomised controlled trials (RCTs) published between 2015 and 2024. METHODS: We searched seven major databases for RCTs comparing acupuncture to control interventions. The primary outcomes were changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP). Meta-analyses utilised random-effects models, and the Cochrane Risk of Bias tool assessed study quality. RESULTS: Seven RCTs ( = 812) were included. Acupuncture was associated with lower SBP [mean differences (MD) = -6.73 mmHg, 95% confidence interval (CI): -8.84 to -4.62] and DBP (MD = -6.59 mmHg, 95% CI: -9.42 to -3.76). Heterogeneity was substantial for SBP ( = 73.3%) and considerable for DBP ( = 90.9%). Notably, the SBP analysis included seven studies, whereas the DBP analysis included six studies, and the similar absolute pooled reductions should be interpreted cautiously, given the small and not fully overlapping study sets. Exploratory subgroup analyses suggested blood pressure reductions across several acupuncture modalities, though each subgroup contained very few studies. Adverse-event reporting was limited and inconsistent across studies. Formal tests for publication bias were underpowered given the small number of included studies. CONCLUSIONS: Acupuncture may have blood pressure-lowering effects in patients with primary hypertension, but the evidence is limited by substantial heterogeneity, a small number of studies and considerable variation in intervention type and exposure. Larger, well-designed, multi-centre RCTs with standardised protocols and longer follow-up are needed to confirm these findings and establish optimal treatment parameters.
PURPOSE: Hypertension remains the leading modifiable risk factor for cardiovascular morbidity and premature mortality worldwide. While its prevalence has declined across much of Europe in recent decades, this trend has n...PURPOSE: Hypertension remains the leading modifiable risk factor for cardiovascular morbidity and premature mortality worldwide. While its prevalence has declined across much of Europe in recent decades, this trend has not been observed in the Balkan region, where rates remain persistently high. This narrative review aims to synthesise current evidence on the epidemiology of hypertension in the Balkans and to explore potential determinants underlying this sustained burden. MATERIALS AND METHODS: We conducted a narrative review of available literature, including population-based surveys, reports from the World Health Organization, and national epidemiological data from Balkan countries. Relevant studies were identified to evaluate prevalence patterns and associated determinants of hypertension across the region. RESULTS: Data consistently indicate that hypertension prevalence in most Balkan countries approaches or exceeds 50% of the adult population. However, notable intra-regional variation exists, with Türkiye and Greece demonstrating prevalence levels closer to global averages. The excess burden of hypertension in the Balkans appears to be multifactorial, associated with persistently high dietary salt intake, socioeconomic disparities, structural limitations in healthcare systems, and region-specific environmental influences. These factors act synergistically rather than independently. CONCLUSION: The Balkan region represents a distinct epidemiological hotspot for hypertension within Europe. The sustained high prevalence is likely driven by the convergence of multiple interacting determinants, in contrast to Western Europe where long-term investments in primary care-based prevention have led to declining rates. Effective management of hypertension in the Balkans will require integrated, context-specific strategies that extend beyond individual-level interventions.
BACKGROUND: Office blood pressure (BP) measurement is the cornerstone of hypertension diagnosis and risk stratification. Inaccurate BP readings can lead to significant misclassification, often overestimating BP and promp...BACKGROUND: Office blood pressure (BP) measurement is the cornerstone of hypertension diagnosis and risk stratification. Inaccurate BP readings can lead to significant misclassification, often overestimating BP and prompting unnecessary lifelong treatment. The Young Investigators Group of the European Society of Hypertension (YIG-ESH) conducted a structured, comprehensive survey among ESH Excellence Centres with the primary objective of providing an updated overview of BP measurement practices in routine clinical care. METHODS: A 17-item survey was created to assess the different modalities, devices and techniques currently used for office BP measurement (OBPM) across ESH excellence centres. The survey was spread email for 8 weeks (from December 2024 to February 2025). RESULTS: The survey was sent out to 216 recipients and 96 responses have been collected (response rate 44%) from 29 different countries. Automated electronic devices were used routinely in almost all outpatient facilities (96.7%), while manual auscultatory devices were used in 33.3% of the healthcare facilities. Among manual auscultatory devices, aneroid devices were used by the majority of the participants (73.6%) and mercury sphygmomanometers by 28.8%. BP was measured in seated (91.7%), standing (43.8%) and supine position (32.3%). Most of the respondents performed three (68.8%) or two (22.9%) BP measurements per outpatient. Home BP monitoring was routinely advised by 98.9% of the respondents providing precise instructions on how to perform the required home BP measurements. CONCLUSION: Our survey reveals considerable discrepancies in BP measurement, even within highly specialised settings such as the ESH Excellence Centres, with substantial non-adherence to recommended guidelines.
OBJECTIVE: As a blood pressure clinic, we have developed a hypertension action bundle including a training programme to facilitate secondary hypertension screening, delivered during three phases: P1 (2016-2018): for hosp...OBJECTIVE: As a blood pressure clinic, we have developed a hypertension action bundle including a training programme to facilitate secondary hypertension screening, delivered during three phases: P1 (2016-2018): for hospital practitioners; P2 (2019-2021): for practitioners working outside of hospitals; P3 (2022-2024): consolidation phase. We hypothesised that a training programme could enhance diagnosis of primary aldosteronism (PA). DESIGN AND METHOD: This study included patients diagnosed with PA between 2016 and 2024. The primary objective was to investigate the incidence of PA diagnosis across three distinct time periods. In addition, we investigated patient origin, reason for consultation and clinical-biological profile, with a view to gaining insight into the diagnostic process. RESULTS: A total of 110 PA patients were diagnosed with PA. The annual incidence of primary aldosteronism (PA) per 1000 consultations increased significantly from 1.2 in P1 to 2.64 in P2 (Odds Ratio P1-P2: 2.2 [95CI, 1.2-4.1]) and 4.31 in P3 (Odds Ratio P2-P3: 1.6 [95CI, 1.1-2.4]). This increase can be primarily attributed to enhanced screening by general practitioners and cardiologists. PA screening indications had also evolved over time, shifting from hypokalaemia and hypertension with target organ damage in P2, to pre-eclampsia, refractory hypertension or hypertension in young patients in P3. There was little to no change in patient's clinic-biological profile between periods. CONCLUSION: The hypertension action bundling including training of physicians in the management of high blood pressure has resulted in significant advancements in the diagnosis and management of PA, through the identification of less common hypertension profiles.
INTRODUCTION: Arterial hypertension is a leading modifiable cardiovascular risk factor. Recent guidelines recommend single-pill, low-dose combinations as initial pharmacological strategy. We investigated the long-term fe...INTRODUCTION: Arterial hypertension is a leading modifiable cardiovascular risk factor. Recent guidelines recommend single-pill, low-dose combinations as initial pharmacological strategy. We investigated the long-term feasibility and sustained effect of such a strategy in a remote rural area of Southern Rwanda, in sub-Saharan Africa. METHODS: Hypertension was diagnosed using three sets of blood pressure measurements obtained according to European Society of Hypertension recommendations using a validated oscillometric device (OMRON M7 IT-HEM-7322-E). Individuals meeting diagnostic criteria were initiated on a single-pill combination of amlodipine, hydrochlorothiazide, and olmesartan. Treatment dosage was reassessed and adjusted as needed at each outpatient clinic visit. RESULTS: Fifty-seven Black African participants with confirmed uncomplicated, untreated hypertension (aged 65 [54-70] years; median and interquartile range) had follow-up data available for up to 24 months after inclusion. Blood pressure <140/90 mm Hg was achieved in 37 (65%) participants after 1 month, 51 (89%) after 3 months, 44 (77%) after 6 months, 43 (75%) after 12 months, and 47 (83%) after 24 months. CONCLUSION: Long-term management of arterial hypertension with a once-daily single-pill combination of amlodipine, hydrochlorothiazide, and olmesartan as initial therapy is feasible in a rural sub-Saharan African setting. Blood pressure reduction is sustained for at least 24 months. Single-pill combinations should be made accessible even in remote areas of low- and middle-income countries.
Pikkemaat M, de Pinho R, Rodilla E
… +18 more, Weber T, Kreutz R, Frese T, Johansson M, Jelakovic B, Bralic Lang V, Dahle N, Torzsa P, Oostindjer A, Evangelidis N, Triantafyllou A, Doumas M, Fragkoulis E, Albini F, Boivin JM, Norrman A, Stomby A, Nemcsik J
BACKGROUND: Hypertension management guidelines provide recommendations for optimal patient care. However, the limited time available of clinicians is rarely considered. The aim of this study was to evaluate the time clin...BACKGROUND: Hypertension management guidelines provide recommendations for optimal patient care. However, the limited time available of clinicians is rarely considered. The aim of this study was to evaluate the time clinicians currently spend on different components of hypertension care during an average workday and to assess physicians' perceptions of the time required for optimal, guideline-based care. METHODS: We conducted an international, cross-sectional, anonymous questionnaire-based survey among physicians involved in hypertension care. A 37-item questionnaire assessed time spent on, and time perceived as necessary for, guideline-recommended hypertension-related activities during an average workday. The survey was distributed through the European Society of Hypertension (ESH) and the European General Practice Research Network (EGPRN) between 1 June and 15 September 2025. RESULTS: 370 responses were collected from 49 countries worldwide (91.3% from Europe). After data clarification 357 responses were analysed. Of these, 153 (42.9%) were general practitioners (GPs) and 204 (57.1%) were other specialists (internists, cardiologists, nephrologists). Across all assessed activities, clinicians consistently reported a gap between the time currently spent and the time perceived as necessary for optimal care, including office blood pressure measurement, home blood pressure measurement education, lifestyle counselling, and cardiovascular risk stratification. Differences were also observed between the practice of GPs and other specialists. CONCLUSIONS: This international survey demonstrates substantial perceived gaps between available and required time for several components of hypertension care, particularly in general practice. These findings highlight the importance of considering real-world clinician time constraints in the development and prioritisation of hypertension guideline recommendations and suggest that adequate health-system resources are needed to support their implementation.
BACKGROUND: Isolated systolic hypertension (ISH), defined as blood pressure of ≥140/<90 mmHg, is associated with an increased risk of cardiovascular complications yet few estimates of prevalence are recorded globally. Da...BACKGROUND: Isolated systolic hypertension (ISH), defined as blood pressure of ≥140/<90 mmHg, is associated with an increased risk of cardiovascular complications yet few estimates of prevalence are recorded globally. Data on blood pressure measurements of adult Filipinos were taken as one of the variables in the National Nutrition Survey; however, the prevalence of ISH and its associated risk factors has not been investigated. This study aimed to determine the prevalence and factors associated with ISH among middle-aged (40-59 years) and older (60 and above) Filipinos. METHODS: A secondary data analysis of the cross-sectional survey design of the 2018, 2019, and 2021 Expanded National Nutrition Survey (ENNS) of the Department of Science and Technology-Food and Nutrition Research Institute (DOST-FNRI) was utilised in the study. Multivariable logistic regression analysis was employed to determine the factors significantly associated with ISH. RESULTS: The prevalence of ISH from the pooled data was 9.10% (95% CI: 8.68-9.53) and increased significantly with age. After adjustment, multivariable analysis identified several factors significantly associated with ISH, the factors included: age, with those 70 years old of age or older exhibiting the highest odds [AOR 11.71 (95% CI: 8.38-16.35)], having little to no formal education [AOR 1.39 (95% CI: 1.18-1.64)], the presence of diabetes [AOR 1.62 (95% CI: 1.38-1.90)], or prediabetic [AOR 1.37 (95 CI: 1.13-1.66)], a family history of hypertension [AOR 2.26 (95% CI: 2.03-2.52)], and current alcohol drinker [AOR 1.24 (95% CI: 1.08-1.43)]. CONCLUSION: ISH was prevalent among middle-aged and older Filipino population across the three survey periods. Given the impact of ISH on cardiovascular outcomes, these findings may provide crucial data on its prevalence and determinants, which can assist policymakers in formulating targeted interventions centred on lifestyle modifications.
BACKGROUND: Baroreflex activation therapy (BAT) has emerged as a device-based therapy for resistant hypertension. Comparative evidence between first-generation (Rheos) and second-generation (Barostim Neo) BAT systems rem...BACKGROUND: Baroreflex activation therapy (BAT) has emerged as a device-based therapy for resistant hypertension. Comparative evidence between first-generation (Rheos) and second-generation (Barostim Neo) BAT systems remains limited. METHODS: We retrospectively analysed all patients who underwent BAT implantation between 2006 and 2015 ( = 54) at our centre. The primary outcome was the change in 24h ambulatory blood pressure monitoring (ABPM) between device generations. Secondary outcomes included adverse events, major adverse cardiovascular events (MACE), kidney function, and device-related complications. Office blood pressure, 24h ABPM, and heart rate (HR) were assessed at baseline and during follow-up. Patients with insufficient 24h ABPM follow-up data were excluded from the primary endpoint analysis. RESULTS: In patients with ABPM data ( = 33), BAT significantly reduced 24h diastolic blood pressure (DBP), 24h systolic blood pressure (SBP), and HR (all < 0.05). Daytime SBP, DBP, and HR decreased significantly. At night, SBP declined from 165 to 151 mmHg ( = 0.004) and DBP from 98 to 88 mmHg ( = 0.003), while HR remained unchanged. Rheos was associated with significant reductions in 24h and night-time SBP; daytime SBP decreased numerically but did not reach statistical significance. Barostim Neo ( = 14) reduced 24h and daytime HR ( = 0.006 and = 0.009) but showed no statistically significant BP reduction. No significant differences were observed between devices in complication rates, kidney function, or MACE. CONCLUSION: Baroreflex activation was safe and associated with reductions in 24h blood pressure and heart rate in patients with resistant hypertension. The first-generation Rheos system demonstrated more pronounced blood pressure-lowering effects, whereas the second-generation Neo system was associated primarily with heart rate reduction without a significant effect on blood pressure. Although Rheos is no longer commercially available, these findings highlight the importance of electrode design, implantation strategy, and patient selection in optimising the efficacy of contemporary BAT.
BACKGROUND: There is a correlation between triclocarban exposure and adverse health effects, but the association between triclocarban and hypertension remains unknown. This study is to investigate the relationship betwee...BACKGROUND: There is a correlation between triclocarban exposure and adverse health effects, but the association between triclocarban and hypertension remains unknown. This study is to investigate the relationship between urinary triclocarban and the risk of hypertension in adults. METHODS: Participants were enrolled from the National Health and Nutrition Examination Surveys. The urinary concentrations of triclocarban were measured by derivatization gas chromatography-mass spectrometry. Odds ratio (OR) and 95% confidence interval (CI) of urinary triclocarban associating with hypertension were estimated with by multivariable logistic regressions. Non-linear correlations were explored using restricted cubic splines. Subgroup analysis was carried out to examine the interactive effects. RESULTS: The highest tertiles of triclocarban comparing the lowest tertiles was associated with higher risk of hypertension in unadjusted model (OR 1.93, 95%CI 1.53 to 2.44; < 0.001), partly-adjusted model (OR 1.48, 95%CI 1.11 to 1.97; = 0.008), and fully-adjusted model (OR 1.31, 95%CI 1.02 to 1.80; = 0.043). Subgroup analysis showed that the relationship was consistent across gender, age, race, and BMI groups. CONCLUSIONS: Urinary triclocarban was associated with the prevalence of hypertension, after adjusting for traditional risk factors.
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 indepe...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).. 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.