Additional Clinical Perspectives and Key Additions – 2025 ACC/AHA Hypertension Guidelines
Additional Clinical Perspectives and Key Additions – 2025 ACC/AHA Hypertension Guidelines
Source: Supplementary Commentary: Published by the Jordanian Cardiac Society (JCS) on its official platforms at the time of the guideline release in August, based on the (ACC)& (AHA) Hypertension Guidelines, 2025.
Date: November 2025
Target Audience: Primary-care physicians, emergency physicians, internists, and cardiologists.
Keynotes:
1. PREVENT Risk Calculator – Core Variables and Treatment Thresholds
• The PREVENT score replaces the former scores for estimating cardiovascular risk.
• Based on over 3 million contemporary adults (2008–2022), reflecting modern demographics and treatment patterns.
• Calculates both 10-year and 30-year CVD risk.
• Treatment in Stage 1 hypertension (130–139 / 80–89 mm Hg) should be initiated if PREVENT 10-year risk ≥ 7.5 % or if comorbidities exist (diabetes, CKD, ASCVD).
• Core variables included:
1. Age, sex, race/ethnicity
2. Systolic and diastolic blood pressure
3. Total cholesterol and HDL-cholesterol
4. Diabetes status
5. Smoking (tobacco use)
6. Body-mass index (BMI)
7. Chronic kidney disease (CKD)
8. Education / social deprivation index
9. Use of antihypertensive therapy
10. Reproductive history (gestational hypertension or preterm birth in women)
• Access link: https://professional.heart.org/en/guidelines-and-statements/prevent-risk-calculator
2. Pregnancy and Post-Partum Hypertension
• Initiate pharmacologic therapy when BP ≥ 140/90 mm Hg.
• Preferred agents: labetalol, extended-release nifedipine, or methyldopa.
• Contraindicated: ACE inhibitors, ARBs, and direct renin inhibitors.
• Target BP: Maintain < 140/90 mm Hg; avoid excessive lowering (< 130 mm Hg) to prevent placental hypoperfusion.
• Monitoring:
• Measure BP within 72 h postpartum,
• Repeat at 7–10 days, then 6–12 weeks.
• Classification: Persistent hypertension beyond 12 weeks = chronic hypertension.
• Long-term impact: Hypertensive disorders of pregnancy and pre-eclampsia are now major cardiovascular risk enhancers in the PREVENT model.
3. Central Nervous System (CNS) and Cerebrovascular Disease
• Hypertension is the leading modifiable factor for stroke, intracerebral hemorrhage (ICH), and cognitive decline.
A. Acute Ischemic Stroke
1. Before thrombolysis/thrombectomy: reduce BP < 185/110 mm Hg.
2. Without reperfusion therapy: treat only if SBP > 220 or DBP > 120 mm Hg.
3. Post-reperfusion: maintain < 180/105 mm Hg for 24 h.
B. Intracerebral Hemorrhage (ICH)
1. Lower systolic BP rapidly but safely to ≈ 140 mm Hg within 1 hour.
2. Avoid reductions < 110 mm Hg.
3. IV options: nicardipine, clevidipine, or labetalol.
C. Long-Term Prevention
• Maintain BP < 130/80 mm Hg post-stroke or TIA.
• Tight control reduces recurrence, cognitive decline, and dementia.
4. Additional Organ Protection and Screening
• Urine albumin-to-creatinine ratio (UaCr): mandatory at diagnosis and follow-up.
• Primary hyperaldosteronism: screen in resistant, early-onset, or severe hypertension.
• Microvascular protection: include renal, retinal, and cerebral monitoring.
• Cognitive health: sustained systolic < 130 mm Hg helps delay small-vessel disease.
5. Clinical Note – Immediate-Release Oral Nifedipine
Immediate-release oral (Not SL)nifedipine may be used only in pregnancy-related severe hypertension (≥ 160/110 mm Hg) as a safe, rapid option when IV access is unavailable.
Outside pregnancy, it should not be used for hypertensive emergencies and is rarely appropriate for urgencies; safer oral or IV agents (labetalol, captopril, clonidine, nicardipine) are preferred to avoid abrupt, harmful BP reductions.
6. Key Take-Home Points
1. BP Target: < 130/80 mm Hg for most adults; individualize for frail or pregnant patients.
2. Risk Assessment: Use PREVENT score (≥ 7.5 % = pharmacologic threshold).
3. Pregnancy: Treat at 140/90 mm Hg; avoid RAAS blockers; monitor postpartum.
4. CNS:
• Thrombolysis: < 185/110 mm Hg
• Intracerebral hemorrhage: ≈ 140 mm Hg
• Long-term: < 130/80 mm Hg
5. Organ Protection: Routine UaCr, endocrine screening, cognitive follow-up.
6. Lifestyle: Weight, diet, physical activity, and smoking cessation remain fundamental.
Jordan Cardiac Society (JCS)
🌐 www.jordan-cardiac.org
🔗 http://jordaniancs.ecardroots.com
Date: November 2025
