2025 AHA/ACC Hypertension Guidelines Summary

2025 AHA/ACC Hypertension Guidelines

Summary:

BP Categories

- Normal: <120/<80 mmHg

- Elevated: 120-129/<80 mmHg

- Stage 1: 130-139 or 80-89 mmHg

- Stage 2: ≥140 or ≥90 mmHg

Lifestyle Modification (First-line for all)

1. DASH diet

2. ↓ Na (sodium reduction)

3. ↑ K (potassium increase, unless CKD)

4. Weight management

5. Moderate activity

6. Stress control

7. Limit alcohol

When to Start Medications

👉👉- Always if BP ≥140/90 mmHg

👉👉If BP ≥130/80 mmHg with:

    1. CVD

    2. Stroke

    3. DM (diabetes mellitus)

    4. CKD (chronic kidney disease)

    5. 10-year CVD risk ≥7.5% (using PREVENT calculator)

- If risk <7.5%: start meds after 3-6 months lifestyle trial if BP still ≥130/80 mmHg

Preferred Therapy

- Stage 2 HTN: 2 first-line drugs in a single-pill combo to improve adherence & speed control.

Special Considerations

- Pregnancy: Treat ≥160/110 mmHg urgently; target <140/90 for chronic HTN; avoid certain medications (ACEI, ARB, etc.); consider low-dose aspirin to ↓ preeclampsia risk.

- Resistant HTN: Screen for secondary cause (Primary aldosteronism); multidisciplinary eval before considering renal denervation.

- Severe HTN (>180/120) w/o acute organ damage: Manage outpatient; no rapid IV/PO BP lowering unless organ injury present.

- Primary goal for prevention of CVD, stroke, dementia, CKD, and mortality: BP <130/80 mmHg for all adults.