"While this was a close race, the voters have spoken, and I congratulate Sheriff Page on his victory," Berger said in a statement.
Berger, North Carolina's government's most influential politician, trailed Page by just two votes out of more than 26,000 counted after the March 3 NC Primary, and Page's lead expanded as elections boards in the two counties composing the district reviewed provisional, absentee and military and overseas ballots.
"Over the past 15 years, Republicans in the General Assembly have fundamentally redefined our state's outlook and reputation. It has been an honor to play a role in that transformation," Berger said Tuesday. "Looking ahead, I remain committed to working with my colleagues in the short session to ensure North Carolina continues to be the best state in the nation in which to live, work, raise a family, and retire. In the months ahead, I will also do everything I can to support all Republican Senate candidates and protect our supermajority."
The result represents a seismic shift in the power structure in the ninth-largest state and likely will soon end Berger's preeminence as the state's top conservative architect.
He has been Senate leader since 2011, when Republicans took full control of the General Assembly for the first time in 140 years.
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Berger requested the hand recount, which was conducted in one precinct in Rockingham County and two in Guilford County.
President Donald Trump had endorsed Berger for reelection, praising him for his policy accomplishments.
Trump's endorsement of Berger occurred several weeks after the legislature redrew the state's U.S. House district map in an attempt to flip a Democratic seat as part of the president's redistricting campaign to retain GOP control of the U.S. House in this year's midterm elections.
Page was outspent by Berger's campaign by more than 50-to-1 through mid-February. That doesn't include several million dollars that a pro-Berger independent expenditure group spent on mailers and advertising.
Berger, a 73-year-old attorney, has been a force in North Carolina government as the General Assembly implemented a rightward agenda despite opposition from a string of mostly Democratic governors, whose inherent powers are relatively weak.
Page, who was first elected sheriff in 1998, tapped into local voter discontent with a narrative that Berger was more interested in the state rather than in looking out for constituents.
Berger's unsuccessful efforts in 2023 to pass a law that could have brought a casino to Rockingham County also angered social conservatives and gave Page an opening.
Even while endorsing Berger in December on social media, Trump praised Page and said he wanted the sheriff to instead "come work for us in Washington, D.C." rather than run against Berger. Page - who had supported Trump's immigration enforcement policies through the years - declined.
Berger first joined the Senate in 2001 and was minority leader before a GOP sweep in the 2010 elections.
Berger figured into every conservative policy prescription since, including income tax reform and reductions, private-school vouchers for any family, restrictions on abortion, and looser regulations on gun access.
With support from the House speaker, Berger also enacted efforts to shift appointment powers away from Democratic Gov. Josh Stein and former Gov. Roy Cooper and toward lawmakers and other officials.
Stein reacted on Tuesday afternoon to the news.
"I thank our election officials for ensuring that all votes were counted and that the people's voice was heard," the governor said. "I congratulate Sheriff Page on his victory and commend Sen. Berger for his service. While we didn't always see eye to eye on the issues of the day, I appreciate Sen. Berger's deep love for North Carolina. I look forward to working with him and other leaders in the General Assembly in the coming weeks to pass a comprehensive, fiscally responsible budget that invests in our state's people."
The General Assembly's chief work session for 2026 begins in April, when Berger's top lieutenants will likely jockey in earnest to succeed him as Senate leader should the GOP maintain a majority in the fall.
The chamber's 50 members pick a leader every two years. Republicans currently hold 30 seats - just enough to override Stein's vetoes.
Despite clashing with Cooper, Berger, and then-Speaker Tim Moore ultimately reached a deal with him to expand Medicaid to hundreds of thousands of adults.
Many of Berger's allies and ex-aides work across state government. His children include a justice on the state Supreme Court, a Rockingham County commissioner, and a state agency attorney.
"Senate President Pro Tempore Phil Berger has been a true titan of conservative leadership in North Carolina," North Carolina House Speaker Destin Hall said Tuesday. "For more than two decades, Sen. Berger has been a stalwart champion of limited government, fiscal responsibility, and the values that have made North Carolina a beacon for families and businesses. North Carolina is stronger, freer, and more prosperous today thanks to Sen. Berger's leadership, and that legacy will endure well into the future, shaping our state for generations to come."
Page will advance to the November general election in the GOP-leaning district. Berger could remain a senator and Senate leader through the year's end. Senators would pick a new chamber leader in early 2027.
Page addressed his primary win shortly after Berger's concession.
"It's not all about the money raised, it's about the trust built in your community," Page said. "You build relationships, and you can build some long-lasting relationships. I think our citizens came out, the trust was there, they showed their support."
-- The Associated Press contributed.
NOTE: Video is from a previous report and will be updated.