Elevated blood pressure is the most important risk factor for cardiovascular disease. Numerous clinical practice guidelines for blood pressure coexist, emanating from European,1,2 North American,3 Asian, and global medical societies. These blood pressure guidelines are scrutinised for their differences, with the focus typically on how they deviate.4 Little attention is given to why they differ. The 2024 European Society of Cardiology (ESC) guidelines1 create an opportunity to take a fresh look at the current landscape of major hypertension guidelines, emphasising the potential reasons these guidelines differ and whether these reasons matter to clinicians and patients.

Elevated blood pressure is the most important risk factor for cardiovascular disease. Numerous clinical practice guidelines for blood pressure coexist, emanating from European,1,2 North American,3 Asian, and global medical societies. These blood pressure guidelines are scrutinised for their differences, with the focus typically on how they deviate.4 Little attention is given to why they differ. The 2024 European Society of Cardiology (ESC) guidelines1 create an opportunity to take a fresh look at the current landscape of major hypertension guidelines, emphasising the potential reasons these guidelines differ and whether these reasons matter to clinicians and patients.