The 2025 AHA/ACC hypertension guideline maintains the <130/80 mmHg treatment goal but adopts a strictly risk-based approach, recommending pharmacotherapy for stage-1 hypertension once the 10-year ASCVD risk reaches 7.5%. Key updates include the race-free PREVENT risk calculator, broader primary aldosteronism screening, routine urine albumin-to-creatinine ratio testing, and cautious incorporation of renal denervation. Clinically, the focus shifts toward precise blood pressure measurement, timely treatment intensification, and widespread use of single-pill combinations for stage-2 hypertension.
PURPOSE OF REVIEW: This review examines the 2025 American Heart Association/American College of Cardiology multisociety hypertension guideline, placing its recommendations in historical context and evaluating the supporting evidence across major clinical populations. RECENT FINDINGS: The 2025 guideline retains the 2017 blood pressure categories and treatment goal of less than 130/80 mmHg but introduces the race-free PREVENT equations, uses a 7.5% 10-year risk threshold to guide pharmacologic treatment of stage-1 hypertension, and encourages systolic blood pressure below 120 mmHg in selected high-risk patients. Additional updates include single-pill combination therapy for stage-2 hypertension, broader primary aldosteronism screening, routine urine albumin-to-creatinine ratio measurement, removal of race-based drug selection, and cautious incorporation of renal denervation. Recent trials strengthen the evidence for intensive lowering, including in diabetes and older adults. The 2025 guideline advances a risk-based, measurement-dependent approach. The principal challenge is no longer identifying effective treatments but delivering accurate measurement, timely intensification, and sustained follow-up at scale.
