AHA and ACC Release 2025 Hypertension Guidelines: Focus on Early Intervention and Personalized Care

On August 14, 2025, the American Heart Association (AHA) and the American College of Cardiology (ACC) released updated guidelines for managing high blood pressure in adults. These guidelines emphasize early intervention and personalized treatment strategies to mitigate risks associated with hypertension, such as heart disease, stroke, and cognitive decline.

The 2025 guidelines maintain the blood pressure categories established in 2017:

• Normal: Less than 120/80 mm Hg
• Elevated: 120–129/<80 mm Hg
• Stage 1 Hypertension: 130–139/80–89 mm Hg
• Stage 2 Hypertension: ≥140/≥90 mm Hg

A significant addition is the introduction of the PREVENT™ risk calculator, a tool designed to estimate an individual's 10- and 30-year risk of developing cardiovascular disease. This calculator considers factors such as age, sex, cholesterol levels, and blood pressure, enabling healthcare providers to tailor treatment plans more effectively.

For individuals with blood pressure readings above 140/90 mm Hg or those with additional risk factors like diabetes or chronic kidney disease, the guidelines recommend initiating medication alongside lifestyle modifications. This proactive approach aims to achieve better blood pressure control and reduce the incidence of cardiovascular events.

Recognizing the unique risks associated with hypertension during pregnancy, the guidelines provide specific recommendations to protect both maternal and fetal health. For pregnant individuals exhibiting stage 2 hypertension (≥140/90 mm Hg), the guidelines advise the initiation of antihypertensive medication to prevent complications such as preeclampsia.

The guidelines emphasize a multidisciplinary, team-based approach to hypertension management, involving physicians, pharmacists, nurses, dietitians, and community health workers. This collaborative strategy aims to address structural barriers and improve patient access to care. Additionally, home blood pressure monitoring is encouraged to enhance patient engagement and treatment adherence.

Hypertension is a leading modifiable risk factor for cardiovascular diseases, including coronary artery disease, heart failure, atrial fibrillation, stroke, dementia, and chronic kidney disease. Effective management of blood pressure is crucial in reducing morbidity and mortality associated with these conditions.

The previous major update to hypertension guidelines occurred in 2017, when the AHA and ACC lowered the threshold for diagnosing high blood pressure from 140/90 mm Hg to 130/80 mm Hg. This change increased the prevalence of hypertension diagnoses among American adults from 32% to 46%, highlighting the need for more aggressive management strategies.

Healthcare providers are encouraged to adopt the PREVENT™ risk calculator to personalize treatment plans and to consider earlier initiation of medication in high-risk individuals. The emphasis on early intervention and comprehensive management strategies aims to reduce the overall burden of hypertension-related complications, potentially decreasing healthcare costs and improving population health outcomes. The promotion of home blood pressure monitoring and team-based care models seeks to empower patients in managing their health, leading to better adherence to treatment plans and improved blood pressure control.

The 2025 hypertension guidelines from the AHA and ACC represent a significant advancement in the management of high blood pressure, focusing on early intervention, personalized care, and comprehensive strategies to reduce the risks associated with hypertension.