Revised guidelines suggest promoting medications and unnecessary treatment options for high blood pressure; questioning the validity of what constitutes normal blood pressure levels.
The recently released 2025 AHA/ACC guidelines for the prevention, detection, evaluation, and management of high blood pressure in adults offer updated and expanded recommendations, aiming to improve cardiovascular health and reduce the risk of various diseases.
The guidelines continue to emphasize early and aggressive blood pressure (BP) control to prevent cardiovascular disease (CVD), kidney disease, type 2 diabetes, cognitive decline, and dementia. One of the key changes is the replacement of the previously used pooled cohort equations with the PREVENT risk calculator. This new tool combines cardiovascular, kidney, and metabolic health parameters to provide more precise and individualized cardiovascular risk estimates, guiding treatment decisions more effectively.
Another significant change is the recommendation to start treatment with two antihypertensive medications simultaneously, preferably as a single-pill combination. The guidelines also suggest the possible addition of newer therapies such as GLP-1 receptor agonists for patients with hypertension who are overweight or obese.
There is a stronger focus on screening for secondary causes of hypertension, particularly primary aldosteronism, even without hypokalemia, especially in resistant hypertension cases. The guidelines recommend continuing most antihypertensive medications during screening to avoid delays.
Updates include more detailed guidance for hypertension management in special populations, including those with chronic kidney disease, pregnancy, resistant hypertension, and patients at risk for cognitive impairment.
The guidelines also emphasize lifestyle approaches such as a heart-healthy diet, salt reduction, physical activity, stress management, and maintaining a healthy weight as foundational interventions. There is a stronger endorsement for team-based care, home BP monitoring, and standardized treatment protocols to improve hypertension control in clinical practice.
Compared to the 2017 guidelines, the 2025 guidelines offer more precise risk assessment tools, expand treatment options tailored to patient characteristics, broaden the screening for secondary hypertension, and enhance strategies for implementation and adherence across diverse populations.
It's important to note that nearly half of all adults in the US have higher than normal blood pressure. The goal numbers for adults have not changed, with normal blood pressure being less than 120/80 mm Hg. Maintaining a healthy lifestyle and regular monitoring of blood pressure are crucial in managing high blood pressure and reducing the risk of related health issues.
[1] Link to the official guidelines [2] Link to further reading on the guidelines [3] Link to a news article on the guidelines [4] Link to an analysis of the guidelines [5] Link to a discussion on the implications of the guidelines
- The 2025 AHA/ACC guidelines for high blood pressure management extend their emphasis on lifestyle approaches, recommending a heart-healthy diet, stress management, physical activity, and maintaining a healthy weight as foundational interventions.
- The revised guidelines place a stronger focus on mental health, highlighting the importance of team-based care and standardized treatment protocols to improve hypertension control in clinical practice.
- In an effort to provide more precise and individualized risk estimates, the guidelines have replaced the previously used pooled cohort equations with the PREVENT risk calculator, which combines cardiovascular, kidney, and metabolic health parameters.
- The expanded recommendations in the 2025 guidelines now include screening for secondary causes of hypertension, particularly primary aldosteronism, even without hypokalemia, especially in cases of resistant hypertension.
- The new guidelines also suggest the possible addition of newer therapies like GLP-1 receptor agonists for patients with hypertension who are overweight or obese, aiming to improve cardiovascular health and reduce the risk of related medical conditions such as kidney disease, type 2 diabetes, and cognitive decline.
