Prevention, Early Intervention Highlighted in Updated High Blood Pressure Guidelines

A new joint blood pressure management guideline from the American Heart Association (AHA) and the American College of Cardiology emphasizes early blood pressure treatment, incorporating the PREVENT risk calculator to personalize care, and close perinatal blood pressure monitoring.¹

“High blood pressure is the most common and most modifiable risk factor for heart disease,” guideline writing committee chair Daniel W. Jones, MD, FAHA, dean and professor emeritus of the University of Mississippi School of Medicine, said in a statement.² “By addressing individual risks earlier and offering more tailored strategies across the lifespan, the 2025 guideline aims to aid clinicians in helping more people manage their blood pressure and reduce the toll of heart disease, kidney disease, type 2 diabetes, and dementia.”

Almost half (46.7%) of US adults have high blood pressure, and it is the leading cause of death both in the US and globally.¹ The new guideline maintains the high blood pressure criteria from the 2017 version, with normal blood pressure defined as less than 120/80 mm Hg, elevated blood pressure as 120 to 129 mm Hg and less than 80 mm Hg, stage 1 hypertension as 130 to 139 mm Hg systolic or 80 to 89 mm Hg diastolic, and stage 2 hypertension as at least 140 mm Hg systolic or at least 90 mm Hg diastolic.

The guideline was developed in collaboration with 11 other health care organizations and published in the journals Circulation and Hypertension, as well as the Journal of the American College of Cardiology.² It replaces the 2017 version of the guidelines and features significant updates, including recommending use of the PREVENT (Predicting Risk of Cardiovascular Disease Events) risk calculator, a tool developed by the AHA in 2023 to estimate an individual’s risk of heart attack, stroke, or heart failure.

Calculating Heart Disease Risk and Intervening Early

The PREVENT calculator combines cardiovascular, kidney, and metabolic health measures to estimate cardiovascular disease risk, and the tool’s precision can help providers personalize treatment strategies to an individual’s cardiovascular disease risk.³ PREVENT estimates the 10- and 30-year risk of cardiovascular disease in individuals aged 30 to 79 years. The tool also includes patient zip code as a proxy for social determinants of health.

Notably, the new 2025 guideline also recommends laboratory testing at initial evaluation for the ratio of urine albumin and creatinine (which was recommended as optional in the 2017 guideline) for all patients with high blood pressure and expands the indication for plasma aldosterone-to-renin ratio testing.¹ The albumin and creatinine ratio test assesses kidney function and can detect kidney disease early, whereas the aldosterone-to-renin ratio screens for primary aldosteronism, which causes high blood pressure and low potassium levels.

The guideline also notes that more than 1 medication may be needed to control blood pressure in many patients, especially individuals with type 2 diabetes, obesity, or kidney disease. Several blood pressure medications to treat patients with high blood pressure were highlighted, including angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), long-acting dihydropyridine calcium channel blockers, and thiazide-type diuretics. Clinicians may need to increase doses or add an additional medication from a different class when 1 medication does not bring blood pressure down to below 130/80 mm Hg. When blood pressure levels are 140/90 mm Hg or above, the recommendation is to start with 2 medications at once, ideally in a combination pill.

Lifestyle and Blood Pressure Control

The new guideline emphasizes the role of lifestyle behaviors in high blood pressure, recommending that providers help patients set realistic goals. Lifestyle choices are the first line of care for all adults, according to the guideline.

Key lifestyle behaviors include limiting sodium intake, consuming no alcohol, managing stress with exercise, maintaining a healthy weight, eating healthy foods, completing 75 to 150 minutes of aerobic and resistance exercise per week, and home blood pressure monitoring.

Pregnancy and the impacts of perinatal high blood pressure on heart health were also highlighted in the guideline, which recommends treatment for pregnant women whose systolic blood pressure reaches 140 mm Hg or higher and/or diastolic blood pressure reaches 90 mm Hg or higher. This narrower guideline accounts for evidence that keeping blood pressure within this range may reduce the risk of serious complications. The guidelines also urge blood pressure monitoring during the postpartum period to prevent complications.

“This updated guideline is designed to support health care professionals—from primary care teams to specialists, and to all clinicians across health systems—with the diagnosis and care of people with high blood pressure,” Jones said. It also empowers patients with practical tools that can support their individual health needs as they manage their blood pressure, whether through lifestyle changes, medications, or both.”

References

1. New high blood pressure guideline emphasizes prevention, early treatment to reduce CVD risk. News release. American Heart Association. August 14, 2025. Accessed September 2, 2025. https://newsroom.heart.org/news/new-high-blood-pressure-guideline-emphasizes-prevention-early-treatment-to-reduce-cvd-risk

2. 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. Circulation. Published online August 14, 2025. doi:10.1161/CIR.0000000000001356

3. Khan SS, Coresh J, Pencina MJ, et al. Novel prediction equations for absolute risk assessment of total cardiovascular disease incorporating cardiovascular-kidney-metabolic health: a scientific statement from the American Heart Association. Circulation. 2023;148(24):1982-2004. doi:10.1161/CIR.0000000000001191