AHA/ACC Release New Blood Pressure Management Guideline

The American Heart Association (AHA) and the American College of Cardiology (ACC) have jointly released an updated guideline on the prevention and management of high blood pressure (BP) in adults.

The guideline, “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”, updates the recommendations provided in a 2017 guideline, with several major changes, including the use of the AHA’s PREVENT (predicting risk of cardiovascular disease events) risk calculator, which combines measures of cardiovascular, kidney, and metabolic health to estimate cardiovascular disease (CVD) risk and help guide treatment decisions. 

Based on PREVENT, the revised recommendations regarding the use of BP-lowering medication in adults with hypertension include the following:

• For those without clinical CVD but with diabetes or chronic kidney disease or at increased 10-year CVD risk (ie, ≥7.5%), starting BP-lowering medication is recommended when average BP is 130/80 mm Hg or higher. 
• For those without clinical CVD and with estimated 10-year CVD risk less than 7.5%, starting BP-lowering medication is recommended if BP remains at 130/80 mm Hg or higher after 3 to 6 months of lifestyle changes.

For patients with type 2 diabetes, obesity, or kidney disease, more than 1 medication may be necessary to meet the BP treatment goal of less than 130/80 mm Hg. Individualizing therapy either by increasing the dose or adding a second medication from a different drug class may be necessary in some cases. 

For patients with stage 2 hypertension, the guideline maintains the use of 2 medications at once, preferably in a single pill to improve medication adherence. The addition of a glucagon-like peptide-1 receptor agonist may also benefit those with hypertension and overweight or obesity.

While optional in 2017, the new guideline now recommends the urine albumin-to-creatinine ratio test for all patients with hypertension to assess kidney health. Additionally, the indication for use of the plasma aldosterone-to-renin ratio test as a screening tool for primary aldosteronism has been expanded to include additional patients such as those with obstructive sleep apnea. To increase rates of detection, screening for primary aldosteronism may be considered for patients with stage 2 hypertension (BP levels ≥140/90 mm Hg). 

The updated recommendations also address the link between hypertension and cognitive decline and dementia. Based on the most recent research, it is now recommended that treatment be started early in patients diagnosed with high BP in order to prevent cognitive impairment, with a systolic blood pressure goal of less than 130 mm Hg.

The new guideline also discusses the need for hypertension management during pregnancy, noting that tighter BP control in individuals with chronic hypertension may reduce the risk of serious complications. Additionally, for individuals with hypertension who are planning a pregnancy or are pregnant, the use of low-dose aspirin should be considered to reduce the risk of preeclampsia.

“High blood pressure is the most common and most modifiable risk factor for heart disease,” said Chair of the guideline writing committee Daniel W. Jones, MD, FAHA, dean and professor emeritus of the University of Mississippi School of Medicine in Jackson, Mississippi, and was a member of the writing committee for the 2017 high blood pressure guideline. “By addressing individual risks earlier and offering more tailored strategies across the lifespan, the 2025 guideline aims to aid clinicians in helping more people manage their blood pressure and reduce the toll of heart disease, kidney disease, type 2 diabetes and dementia.” 

The full 2025 guideline is available here.  

This article originally appeared on MPR