Article Impact Level: HIGH Data Quality: STRONG Summary of Hypertension, HYP.0000000000000249. https://doi.org/10.1161/HYP.0000000000000249 Dr. Daniel W. Jones et al.
Points
- The overarching blood pressure treatment goal remains <130/80 mm Hg, with hypertension defined as stage 1 at 130–139/80–89 mm Hg and stage 2 at ≥140/90 mm Hg.
- Medication is now recommended at ≥130/80 mm Hg for adults with CVD, diabetes, CKD, or a 10-year PREVENT risk of ≥7.5% to reduce cardiovascular events and mortality.
- For pregnant individuals with chronic hypertension, antihypertensive therapy is now recommended to achieve a blood pressure goal of less than 140/90 mm Hg to improve maternal outcomes.
- To proactively prevent mild cognitive impairment and dementia in adults with hypertension, a systolic blood pressure goal of less than 130 mm Hg is now strongly recommended.
- For adults with stage 2 hypertension, initiating treatment with two first-line agents in a single-pill combination is preferred to improve adherence and achieve faster blood pressure control.
Summary
The “2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults” replaces the 2017 iteration, establishing an overarching blood pressure (BP) treatment goal of <130/80 mm Hg for most adults. Based on a comprehensive literature search from December 2023 to June 2024, the guideline maintains BP classifications of normal (<120/80 mm Hg), elevated (120-129/<80 mm Hg), stage 1 hypertension (130-139 or 80-89 mm Hg), and stage 2 hypertension (≥140 or ≥90 mm Hg). A key update is the integration of the PREVENT risk calculator to guide the initiation of therapy.
The guideline revises treatment thresholds, recommending medication for adults with BP ≥130/80 mm Hg who have clinical cardiovascular disease (CVD), diabetes, chronic kidney disease (CKD), or an estimated 10-year CVD risk ≥7.5% via PREVENT. For individuals with a 10-year risk <7.5%, medication is recommended if BP remains ≥130/80 mm Hg after a 3- to 6-month trial of lifestyle modification. The document also introduces new terminology, replacing “hypertensive urgency” with “severe hypertension” for BP >180/120 mm Hg without acute target organ damage. Furthermore, it expands screening for primary aldosteronism to all adults with resistant hypertension and suggests continuing most antihypertensives during initial screening.
New recommendations address specific populations and comorbidities. For pregnant individuals with chronic hypertension, treatment is recommended to achieve a BP <140/90 mm Hg, and low-dose aspirin (81 mg/day) is advised to reduce preeclampsia risk. A systolic BP goal of <130 mm Hg is now recommended to prevent cognitive decline and dementia. For acute intracerebral hemorrhage patients with an SBP between 150 and 220 mm Hg, lowering SBP to 130 to <140 mm Hg can be beneficial. The guideline also includes multiple new recommendations regarding the evaluation and use of renal denervation for resistant hypertension.
Link to the article: https://www.ahajournals.org/doi/10.1161/HYP.0000000000000249
References Jones, D. W., Ferdinand, K. C., Taler, S. J., Johnson, H. M., Shimbo, D., Abdalla, M., Altieri, M. M., Bansal, N., Bello, N. A., Bress, A. P., Carter, J., Cohen, J. B., Collins, K. J., Commodore-Mensah, Y., Davis, L. L., Egan, B., Khan, S. S., Lloyd-Jones, D. M., Melnyk, B. M., … Williamson, J. D. (2025). 2025 aha/acc/aanp/aapa/abc/accp/acpm/ags/ama/aspc/nma/pcna/sgim guideline for the prevention, detection, evaluation and management of high blood pressure in adults: A report of the american college of cardiology/american heart association joint committee on clinical practice guidelines. Hypertension, HYP.0000000000000249. https://doi.org/10.1161/HYP.0000000000000249
