Highlights of the 2026 Korean Society of Hypertension guidelines for the management of hypertension: what's new and what has changed.

Abstract

The recently released 2026 Korean Society of Hypertension (KSH) guidelines incorporate contemporary advances in the diagnosis and management of hypertension. This highlight summarizes the most important updates, focusing on the underlying evidence and key changes, particularly the newly introduced and revised recommendations. The major additions include the incorporation of isolated diastolic hypertension into blood pressure (BP) classification, the first integration of cuffless BP devices into clinical practice, and the incorporation of a new therapy with a BP-lowering effect (angiotensin receptor-neprilysin inhibitors, sodium-glucose cotransporter 2 inhibitors, non-steroidal mineralocorticoid receptor antagonists, and aldosterone synthase inhibitors). A dose-based classification of single-pill combination therapies has been introduced to enhance treatment adherence. In addition, obesity, hypertension in young adults, hypertensive emergencies, and patient-centered care have been incorporated and emphasized. Major updates include expanded screening for primary aldosteronism, adoption of more intensive BP targets, and risk-based initiation of pharmacological therapy in individuals with prehypertension. Lifestyle recommendations have been broadened to include e-smoking cessation and mind-body practices. Furthermore, the definition and management of uncontrolled (or resistant) hypertension have been updated, and BP targets in older adults are now individualized according to frailty status and overall cardiovascular risk; intensive BP lowering to 130/80 mmHg is recommended in selected high-risk older individuals. Finally, BP management during pregnancy has also been refined to emphasize active BP control at < 140/90 mmHg and the use of out-of-office BP measurements for more accurate diagnosis. Overall, the new KSH guidelines provide a more evidence-based framework for hypertension management, with the goal of improving BP control and reducing cardiovascular morbidity and mortality.