Current 57 - 2025 ACC/AHA Guideline for High Blood Pressure in Adults

Summary

The 2025 American College of Cardiology (ACC)/American Heart Association (AHA) Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults identifies hypertension as the predominant modifiable risk factor for cardiovascular disease.¹ The new guideline, which replaces the 2017 guideline, sets a universal treatment target of < 130/80 mmHg, with individualized exceptions for institutionalized patients, those with limited life expectancy, and pregnant individuals¹ and includes the use of the AHA’s PREVENT^TM (Predicting Risk of Cardiovascular Disease EVENTs) risk calculator to estimate cardiovascular disease risk, replacing the Pooled Cohort Equation. Lifestyle modifications remain foundational for the prevention and management of hypertension.

Antihypertensive pharmacotherapy is indicated for individuals with sustained average blood pressures ≥ 140/90 mmHg and for select patients with average blood pressures ≥ 130/80 mmHg who also have established cardiovascular disease, prior stroke, diabetes, chronic kidney disease, or an estimated 10-year CVD risk ≥ 7.5% based on PREVENT^TM. Medication initiation is recommended for lower-risk adults with persistent blood pressure of ≥ 130/80 mmHg after 3 to 6 months of lifestyle therapy. First-line agent selection is race-neutral; all patients without compelling indications should be initiated on a thiazide, angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, or dihydropyridine calcium channel blocker. Stage 2 hypertension (systolic blood pressure ≥ 140 and diastolic blood pressure ≥ 90) should preferentially be treated with single-pill dual-class fixed-dose combinations to improve adherence and reduce time to achieve blood pressure control.

Multidisciplinary, team-based care is recommended to identify and mitigate structural barriers to medication access and adherence.^1-3

Sources

1. Writing Committee Members; Jones DW, Ferdinand KC, Taler SJ, et al. 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. Circulation. 2025;152(11):e114-e218. doi:10.1161/CIR.0000000000001356.

2. Harrison DG, Touyz RM. Hypertension editors' view of the 2025 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Hypertension. 2025;82(10):e193-e195. doi:10.1161/HYPERTENSIONAHA.125.25467.

3. American Heart Association. Top Things to Know: 2025 High Blood Pressure (BP) Guideline. https://professional.heart.org/en/science-news/2025-high-blood-pressure-guideline/top-things-to-know. Published August 14, 2025. Accessed September 12, 2025.

This summary was created with assistance from generative artificial intelligence (Microsoft Copilot, 2025)