The 2026 guidelines, published in theJournal of Hypertension, were developed by 13 authors and reviewed by 24 experts, together representing 23 countries across five continents. The guidelines provide practical guidance for healthcare settings around the world with different resources.

The publication of the guidelines is accompanied by the launch of ISH OnTheGo, an AI-powered application to help healthcare professionals understand the guidelines, as part of a wider global implementation programme.

The new guidelines retain a distinction between ‘Essential care’, which should be available to everyone, and ‘Optimal care’, where resources allow. Healthcare professionals should provide ‘Essential care’ to all patients and incorporate as many elements of ‘Optimal care’ as feasible.

George Stergiou, ISH President for 2024-2026, who led the development of the 2026 ISH guidelines, said: “I am delighted to see these guidelines published. Since the publication of our 2020 guidelines, the evidence has moved on significantly, meaning it is vital that we provide healthcare professionals around the world with clear, practical and up-to-date guidance, both for ‘essential’ care and ‘optimal’ care.

“The next step is implementation. We will now move to rolling out a dedicated global implementation programme to support dissemination of the guidelines across different healthcare settings, with the aim of influencing clinical practice.”

Key features of the new ISH guidelines published in 2026 include:

A recommendation to treat raised blood pressure earlier

The 2020 ISH guidelines classified office blood pressure of 130-139 mmHg systolic and/or 85-89 mmHg diastolic as “high-normal”. The 2020 guidelines generally recommended lifestyle changes, with medication considered mainly for people at very high cardiovascular risk.

The 2026 guidelines replace “High-normal” with “Elevated blood pressure”, defined as 130-139 systolic and/or 80-89 diastolic, bringing diastolic readings of 80-84 into this category.

Under ‘Optimal care’, medication is now recommended for most people with confirmed elevated blood pressure, following three months of lifestyle changes for those at low cardiovascular risk whose blood pressure remains elevated. This means

more people may receive treatment before reaching the office threshold for diagnosing hypertension, which remains 140/90.

Newer treatment options

The 2026 guidelines add recommendations on aldosterone synthase inhibitors and other newer drug classes, and consideration of renal denervation for selected patients at expert centres.

Aiming for lower blood pressure in more people

The 2020 guidelines recommended an optimal blood pressure target below 130/80 mmHg for people under 65, and below 140/90 for those aged 65 and over. The 2026 guidelines recommend a target below 130/80 more broadly under optimal care, including for many older adults, with individualisation according to frailty, treatment tolerance and other clinical circumstances.

A more central role for home monitoring

Whereas the 2020 guidelines recommended home or ambulatory monitoring to confirm diagnosis where possible, the 2026 guidelines recommend standardised home monitoring as the main method for diagnosis and ongoing management under optimal care. They explicitly warn against using casual readings at home or in clinics for hypertension evaluation. Ambulatory monitoring remains important for specific indications where available.

A role for more healthcare professionals to deliver hypertension care

Detailed recommendations are made in the 2026 guidelines for trained and authorised nurses, pharmacists and other health workers to share care, according to their prescribing rights and access to physicians.

Support for healthcare professionals to apply the guidelines

ISH OnTheGo is an AI-powered application that supports healthcare professionals in using and understanding the guidelines. The ISH’s dedicated guidelines implementation programme starting in November 2026 will also support uptake of use of the guidelines.

The 2026 guidelines were officially presented in Dubai at the Scientific Meeting of the ISH in collaboration with the Emirates Cardiac Society, on 24 October 2026.

Kazuomi Kario, who takes over as ISH President at the ISH 2026 Scientific Meeting, said: “Implementation of these guidelines will be a key priority of my Presidency of the ISH, working with partners around the world to address the different challenges of hypertension management in different healthcare settings.”