Cardiologists gathering at ESC Congress 2025 were presented with a raft of late-breaking clinical data and new practice guidelines aimed at fine-tuning cardiovascular care. In the RETREAT-FRAIL study, withdrawing one or more antihypertensive drugs in older frail adults whose systolic blood pressure was already below 130 mm Hg failed to lower all-cause mortality during four years of follow-up, casting doubt on de-intensification strategies for this population. Conversely, the POTCAST trial found that titrating serum potassium into the high-normal range in patients with implantable cardioverter-defibrillators significantly reduced arrhythmic events, cardiovascular admissions and deaths, supporting more aggressive electrolyte management. Another highlight, the phase-4 DIGIT-HF trial, showed that adding digitoxin to guideline-directed therapy in heart-failure patients with reduced ejection fraction trimmed the combined risk of death or heart-failure hospitalization compared with placebo. Remote patch-based ECG screening modestly increased detection of atrial fibrillation and the use of anticoagulants in older adults at elevated stroke risk, but produced only limited changes in stroke incidence, according to a multicenter study also reported at the meeting.