Today, I review, link to, and excerpt from JACC‘s “2025 High Blood Pressure Guideline-at-a-Glance”. Martha Gulati, Mykela M. Moore, and Morgane Cibotti-Sun. JACC Volume 86, Number 1. Societal Statement, 15 August 2025.
All that follows is from the above resource.
Introduction
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 (AHA/ACC/Multisociety HBP Guideline)1 contextualizes the most recent clinical evidence in treating patients with one of the most modifiable cardiovascular disease (CVD) risk factors, high blood pressure (HBP). The discussion around HBP is quite expansive, and this guideline highlights the impact of HBP globally, provides guidance on multidisciplinary team-based care, and encourages the use of a new tool to calculate risk. The guideline contains updated, evidence-based recommendations that replaces those from the 2017 HBP guideline.2 This Guideline-at-a-Glance highlights practice-changing recommendations from the guideline to accelerate adoption.Central Illustration 2025 High Blood Pressure Guideline-at-a-GlanceBP = blood pressure; CVD = cardiovascular disease; HF = heart failure; MI = myocardial infarction; PREVENT = Predicting Risk of cardiovascular disease EVENTs; SDI = social deprivation index.Top Take-Home Messages
The following Top Take-Home Messages are taken directly from the AHA/ACC/Multisociety HBP Guideline. Messages 1, 5, and 7 (in bold below) were selected as key themes for this Guideline-at-a-Glance because they outline the most impactful changes and address established gaps in clinical practice.
1.HBP is the most prevalent and modifiable risk factor for the development of CVDs, including coronary artery disease, heart failure, atrial fibrillation, stroke, dementia, chronic kidney disease, and all-cause mortality. The overarching blood pressure treatment goal is <130/80 mm Hg for all adults, with additional considerations for those who require institutional care, have a limited predicted lifespan, or are pregnant.2.Clinicians should collaborate with community leaders, health systems, and practices to implement screening of all adults in their communities and implement guideline-based recommendations regarding prevention and management of HBP to improve rates of blood pressure control.3.Multidisciplinary team-based care is effective in assessing and addressing patient access to medications and other structural barriers to support individual patient needs and thereby reduce barriers to achieving hypertension control. Team members may include physicians, pharmacists, nurse practitioners, nurses, physician assistants/associates, dieticians, community health workers, and other health care professionals.4.Blood pressure is classified by the following framework: normal blood pressure is defined as <120 mm Hg systolic and <80 mm Hg diastolic; elevated blood pressure as 120 to 129 mm Hg systolic and <80 mm Hg diastolic; stage 1 hypertension as 130 to 139 mm Hg systolic or 80 to 89 mm Hg diastolic; and stage 2 hypertension as ≥140 mm Hg systolic or ≥90 mm Hg diastolic.5.For all adults, lifestyle changes, including maintaining or achieving a healthy weight, following a heart-healthy eating pattern (such as DASH [Dietary Approaches to Stop Hypertension]), reducing sodium intake, increasing dietary potassium intake, adopting a moderate physical activity program, managing stress, and reducing or eliminating alcohol intake are strongly recommended to prevent or treat elevated blood pressure and hypertension.6.Initiation of medication therapy to lower blood pressure in addition to lifestyle interventions is recommended for all adults with average blood pressure ≥140/90 mm Hg and/or for selected adults with average blood pressure ≥130/80 mm Hg who have clinical CVD, previous stroke, diabetes, chronic kidney disease, or increased 10-year predicted cardiovascular risk of ≥7.5% defined by PREVENT™ (Predicting Risk of cardiovascular disease EVENTs).7.In adults with average blood pressure ≥130/80 mm Hg and at lower 10-year CVD risk defined by PREVENT of <7.5%, initiation of medication therapy to lower blood pressure is recommended if average blood pressure remains ≥130/80 mm Hg after an initial 3- to 6-month trial of lifestyle modification.8.For all adults with stage 2 hypertension, the initiation of antihypertensive drug therapy with 2 first-line agents of different classes in a single-pill, fixed-dose combination is preferred over 2 separate pills to improve adherence and reduce time to achieve blood pressure control.9.Home blood pressure monitoring combined with frequent interactions with multidisciplinary team members using standardized measurement and treatment protocols and home measurement protocols is an important integrated tool to improve rates of blood pressure control. Reliance on cuffless devices, including smartwatches, for accurate blood pressure measurements should be avoided until these devices demonstrate greater precision and reliability.10.Severe hypertension in nonpregnant individuals, defined as blood pressure >180/120 mm Hg, without evidence of acute target organ damage, should be evaluated and treated in the outpatient setting with initiation, reinstitution, or intensification of oral antihypertensive medications in a timely manner.The AHA/ACC/Multisociety HBP Guideline emphasizes the need for primary prevention, which plays an important role in managing early stages of hypertension. The 2025 HBP Guideline-at-a-Glance Central Illustration highlights the importance of implementing lifestyle modifications such as adopting a healthier diet and increasing physical activity to prevent progression and reduce long term CVD. In adults with an average blood pressure 130-139/80-89 mm Hg and low CVD risk, medication is recommended after 3 to 6 months of lifestyle modification if blood pressure is not at goal. The illustration focuses on Top Take-Home Message 7.References
1.Jones D.W., Ferdinand K.C., Taler S.J., 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. J Am Coll Cardiol. 2025;86:18: 1567-1678.2.Whelton P.K., Carey R.M., Aronow W.S., et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA 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 Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2017;71:e127-e248.3.McEvoy J.W., McCarthy C.P., Bruno R.M., et al. 2024 ESC guidelines for the management of elevated blood pressure and hypertension. Eur Heart J. 2024;45:3912-4018.
