Multisociety Hypertension Guidelines (Messages to the World)
Multisociety Hypertension Guidelines (Messages to the World)
Source: Hypertension News – December 2025
Keynotes :
1. Broad, Multidisciplinary U.S. Effort
• Guideline developed with 11 U.S. societies (cardiology, nephrology, geriatrics, neurology, pharmacy, nursing, general practice).
• Reflects a team-based, population-level strategy for a country where >45% of adults meet hypertension criteria.
2. Blood Pressure Measurement & Diagnosis
• Use validated automated office devices; avoid cuffless devices.
• ABPM/HBPM required in most patients for diagnosis and titration.
• ABPM has stronger evidence, but HBPM is more practical and widely recommended.
3. Screening for Primary Aldosteronism
• Broader screening indications: resistant HTN, hypokalemia, sleep apnea, adrenal incidentaloma, early-onset HTN, stroke <40 yrs.
• Screening can be done while continuing most antihypertensives (stop MRAs & beta-blockers).
4. New Risk Assessment Model
• Recommend AHA PREVENT™️ to assess 10–30-year cardiovascular risk.
• Includes kidney markers (UACR), HbA1c, BMI, and social deprivation index.
5. When to Start Treatment
• Start at >140/90 mmHg for all adults.
• Start at ≥130/80 mmHg if:
• Diabetes
• CKD
• 10-year CVD risk ≥7.5%
• Lower-risk patients can try lifestyle first (3–6 months).
6. BP Treatment Targets
• Goal for nearly all adults = <130/80 mmHg.
• Encouragement to reach SBP <120 mmHg in many patients (Class IIb) — based on meta-analysis showing net CV benefit.
• Opposes 2024 ESH guidance (which discourages <120 mmHg).
7. Monotherapy vs Combination
• Stage 1 (130–139/80–89): monotherapy reasonable.
• Stage 2 (≥140/90): start 2-drug combination, ideally a single-pill combo.
8. Renal Denervation
• Consider in:
• Resistant HTN: ≥140/90 on ≥4 drugs (ACEi/ARB + CCB + thiazide-type diuretic + MRA).
• Uncontrolled HTN when optimal dosages cannot be used.
• Growing global acceptance; requires referral to expert centers.
9. Framework for Improving BP Control
Eight essentials:
Team-based care, accurate BP measurement, prompt treatment, patient engagement, HBPM review, adherence checks, monthly visits until control, telehealth/EHR integration.
10. Global Perspective
• AHA/ACC guidelines remain influential despite U.S.-specific resources.
• ISH emphasizes the need for practical, adaptable frameworks (Essential vs. Optimal recommendations) to improve BP control worldwide.
• Team-based models and standardized BP measurement are universally critical.
