This consensus document, produced by the Portuguese Society of Hypertension and the Portuguese Society of Cardiology, seeks to harmonise partially divergent hypertension guidelines into actionable clinical recommendations for routine practice. It presents a pragmatic synthesis of the 2023 European guidelines and the 2024 ESC guidance, alongside the 2025 AHA/ACC framework, organized according to the M.A.P.E. (Measure, Assess, Prescribe, Evaluate) framework to support decision-making. The groups emphasize that, across European guidance, hypertension is defined as a blood pressure of at least 140/90 mmHg, with alignment on cardiovascular risk assessment, lifestyle modification, and initial combination therapy using two agents from a common pool. Divergences exist in classification schemes, initiation thresholds, dosing strategies, and target BP goals; the 2025 AHA/ACC guidelines adopt lower diagnostic and treatment thresholds (≥130/80 mmHg) with earlier pharmacologic intervention based on individual cardiovascular risk. The Portuguese consensus acknowledges these differences and endorses a risk-based approach grounded in randomized trial evidence, prioritizing feasibility and patient safety, and relying on office-based BP measurements for treatment decisions.
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 .
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.
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.
This consensus aims to reduce clinical uncertainty and optimise hypertension management in real-world practice providing clear and evidence-informed clinical recommendations.
High blood pressure, also called hypertension, is one of the most common health problems worldwide. It greatly increases the risk of heart and kidney disease. To help doctors and patients manage hypertension effectively, several international organisations regularly update their treatment recommendations, known as clinical guidelines.This article summarises and compares the most recent guidelines from three major scientific organisations: 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). Although these guidelines share the same goal – improving blood pressure control and preventing heart, brain and kidney complications – they differ in certain clinical details, such as when to start medication, how much to lower blood pressure, and the targets to achieve.This consensus document, developed by the Portuguese Society of Hypertension and the Portuguese Society of Cardiology, combines different guidelines on high blood pressure to offer clear and practical advice for everyday patient care.The European guidelines agree on defining hypertension as blood pressure at or above 140/90 mmHg. They also recommend lifestyle changes, regular monitoring, and the use of the same main types of blood pressure-lowering medicines. In contrast, the American guidelines use lower thresholds (from 130/80 mmHg) and encourage earlier medicine treatment in people at higher cardiovascular risk.The Portuguese consensus acknowledges these differences and supports a risk-based approach that is based on results from clinical trials, is practical for everyday care, and prioritises patient safety, using blood pressure measured in the clinic to guide treatment decisions.By bringing together European and American guidelines, this Portuguese consensus aims to reduce uncertainty for healthcare professionals and help improve the everyday management of high blood pressure through well-defined and practical recommendations.