The new ACC/AHA 2025 Hypertension Guidelines Scientific Summary.
The new ACC/AHA 2025 Hypertension Guidelines Scientific Summary.
Source& Date : Medscape,August 14, 2025.
Key Points :
1. Definition of Hypertension in the 2025 ACC/AHA Guidelines(Same as AHA/ACC 2017 ):
• Normal BP: Less than 120/80 mm Hg
• Elevated BP: 120–129 mm Hg systolic and <80 mm Hg diastolic
• Stage 1 Hypertension: 130–139 mm Hg systolic or 80–89 mm Hg diastolic
• Stage 2 Hypertension: ≥140 mm Hg systolic or ≥90 mm Hg diastolicBP
• Targets & Early Initiation
• Treatment target remains <130/80 mmHg for adults.
• Drug therapy should begin earlier if BP ≥130/80 mmHg after 3–6 months of lifestyle changes.
• Previous threshold (≥140/90 mmHg) for primary prevention has been lowered.
2. Immediate Therapy Indications
• Initiate antihypertensive therapy promptly in patients with:
* Diabetes mellitus
* Chronic kidney disease
* Elevated 10-year cardiovascular risk (using PREVENT calculator, AHA 2023).
3. Optimal Goals
• Clinicians should encourage achieving <120/80 mmHg when possible for maximal risk reduction.
• DASH diet (fruits, vegetables, low-fat dairy, fish, poultry, beans, nuts) continues to be strongly recommended.
4. New Evidence Incorporated
• Research from 2015–2024 integrated into guideline updates.
• Emphasis on the link between hypertension and dementia: intensive BP control reduces dementia risk.
• Lifestyle strategies (reduced salt, physical activity, weight loss, stress control) also shown to reduce cognitive decline.
5. Laboratory & Diagnostic Updates
• Urine albumin/creatinine ratio testing (microalbuminuria) is now mandatory for all hypertensive(previously optional) :
* It’s is an early warning sign of kidney injury, often before serum creatinine or eGFR abnormalities appear.
Even small amounts of albumin in urine are strongly linked to higher risk of heart attack, stroke, and heart failure.
* ACR therefore reflects not only kidney health but also overall vascular & organ damage.
* Detecting albuminuria may change therapy: for example, adding ACE inhibitors or ARBs to protect kidneys and reduce cardiovascular risk.
* Helps clinicians personalize treatment intensity in hypertensive patients.
• Screening for primary aldosteronism in resistant hypertension is recommended, regardless of hypokalemia status.
6. Lifestyle & Pharmacologic Strategies
• Sodium intake recommendation reduced from 2300 mg/day → 1500 mg/day.
• No alcohol recommended for prevention/management; if consumed:
* Men: max 2 drinks/day
* Women: max 1 drink/day (daily limit, not weekly average).
• Weight loss is strongly endorsed; GLP-1 inhibitors may be considered if appropriate.
7. Special Populations
• Pregnancy: Low-dose aspirin recommended to prevent preeclampsia.
• Hypertension in pregnancy predicts lifelong elevated BP risk.
• The 2025 guidelines dedicate more focus to pregnancy compared with 2017.
8. Therapeutic Innovations
• Renal denervation mentioned as a possible adjunct to reduce medication need, but not formally recommended.
• Tailored medication strategies emphasized for patient-specific care.
