2025 AHA/ACC Hypertension: Stepwise Management Updates

2025 AHA/ACC Hypertension: Stepwise Management Updates

Diagnosis & Initiation

BP ≥140/90: Initiate pharmacotherapy immediately.

BP 130–139/80–89: Start drugs for high-risk (CVD, CKD, diabetes, PREVENT 10-yr risk ≥7.5%); otherwise, lifestyle modification, reassess in 3–6 months.

Initial Therapy

Monotherapy: ACEI/ARB, CCB, or thiazide.

Stage 2 (≥140/90 or >20/10 above goal): Dual therapy (prefer ACEI/ARB + CCB/thiazide SPC).

Escalation

Uncontrolled: Triple therapy (ACEI/ARB + CCB + thiazide-like diuretic).

Resistant HTN (≥3 drugs): Add MRA (spironolactone/eplerenone).

Refractory HTN

Assess adherence, exclude secondary causes.

Consider RDN (Class IIb, LOE 8-R) with multidisciplinary input.

Lifestyle Foundation: Salt restriction, DASH diet, weight loss, exercise, alcohol moderation, smoking cessation.

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