New AHA/ACC Guideline Emphasizes Earlier Treatment and Better Blood Pressure Control
USA: A new multisociety guideline from the American Heart Association (AHA) and American College of Cardiology (ACC) emphasizes earlier recognition, confirmation, and treatment of high blood pressure, with most patients encouraged to achieve blood pressure (BP) below 130/80 mm Hg. The recommendations replace the 2017 AHA/ACC hypertension guideline and incorporate evidence from subsequent randomized trials supporting more intensive BP control.
Published in Hypertension in 2025, the guideline retains the BP categories established in 2017 while expanding recommendations on out-of-office monitoring, cardiovascular risk assessment, secondary hypertension screening, lifestyle measures, and pharmacological treatment.
Key Recommendations:
- Maintain current BP categories: Normal BP is defined as systolic BP <120 mm Hg and diastolic BP <80 mm Hg; elevated BP as 120–129 mm Hg with diastolic BP <80 mm Hg; stage 1 hypertension as 130–140 mm Hg or 80–90 mm Hg; and stage 2 hypertension as >140 mm Hg or >90 mm Hg.
- Confirm hypertension outside the clinic: Out-of-office BP measurements are encouraged to confirm a diagnosis and help guide treatment.
- Expand initial laboratory evaluation: Newly diagnosed patients should undergo routine assessment along with urine albumin-to-creatinine ratio and HbA1c testing. Other recommended evaluations include complete blood count, electrolytes, kidney function, lipid profile, thyroid-stimulating hormone, urinalysis, and electrocardiography.
- Screen selected patients for primary aldosteronism: Screening is strongly recommended for patients with resistant hypertension, hypokalemia, obstructive sleep apnea, adrenal nodules, or early stroke before age 40. Screening in all patients with stage 2 hypertension receives a weaker recommendation.
- Use the PREVENT calculator for cardiovascular risk: The PREVENT risk assessment tool replaces the pooled cohort equation and should help guide treatment decisions in patients with stage 1 hypertension.
- Emphasize lifestyle modification: Recommended measures include weight reduction, a healthy diet, lower sodium intake, regular physical activity, smoking cessation, limiting or avoiding alcohol, and stress reduction through approaches such as meditation and breathing exercises.
- Allow lifestyle treatment alone in selected low-risk patients: Adults without diabetes or chronic kidney disease who have stage 1 hypertension and a 10-year cardiovascular disease risk below 7.5% may receive lifestyle treatment for 3–6 months before medication is considered.
- Target BP below 130/80 mm Hg: This is the recommended treatment goal for most patients, with encouragement to achieve systolic BP below 120 mm Hg when appropriate. The recommendation is stronger for individuals with a 10-year cardiovascular disease risk of at least 7.5%.
- Prioritize validated home BP monitoring: Validated oscillometric home monitors should be used for diagnosis and medication adjustment. Cuffless devices such as smartwatches and rings are not recommended for clinical BP assessment.
- Start two medications for most patients with stage 2 hypertension: A single-pill, fixed-dose combination containing two first-line antihypertensive agents is preferred when initiating treatment for adults with stage 2 hypertension.
The guideline also includes recommendations addressing pregnancy, severe hypertension, diabetes, chronic kidney disease, recent stroke, and other specific clinical circumstances. Overall, the update reinforces a shift toward more proactive BP management while allowing treatment decisions to be individualized according to cardiovascular risk and patient circumstances.
Reference:
Jones DW, et al. 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 2025 Oct; 82:e212. DOI: 10.1161/HYP.0000000000000249.40811516.
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