Nouraldeen Manasrah, MD

Here’s the ultra-concise cheat-sheet on today’s AHA/ACC High Blood Pressure Guideline (2025)—what actually changed vs 2017, and how to act on it in clinic. Scope & status Replaces 2017 ACC/AHA; definitions unchanged (Normal <120/80; Elevated 120–129/<80; Stage 1 130–139 or 80–89; Stage 2 ≥140 or ≥90). Universal treatment goal Target <130/80 mm Hg for all adults, with individualization for institutionalized, limited life expectancy, or pregnancy. Risk tool switch Move from Pooled Cohort Equations to PREVENT™ risk calculator to guide decisions (10- and 30-year CVD risk; integrates cardio-renal-metabolic health and social drivers). Use PREVENT to personalize when to add meds at 130/80. When to start drug therapy Start meds for everyone at ≥140/90. At 130/80 to 139/89: Start now if CVD, prior stroke, diabetes, CKD, or PREVENT ≥7.5%. If PREVENT <7.5%: try 3–6 mo lifestyle, then start if still ≥130/80. Combination therapy emphasis For Stage 2 (≥140/90): initiate 2 first-line agents (ACEi/ARB, long-acting DHP-CCB, thiazide-type diuretic) preferably as a single-pill combo to improve adherence. CKD & target organ protection Urine albumin-to-creatinine ratio (UACR) now recommended for all at baseline (was optional). Albuminuria detection informs BP intensity and reno-protective choices. Secondary hypertension—broader screening Primary aldosteronism: screen more liberally (e.g., OSA, Stage 2 HTN, resistant HTN). Continue most antihypertensives (except MRA) during initial ARR screening to avoid delays. Pregnancy & postpartum For chronic hypertension in pregnancy, treat at ≥140/90; consider low-dose aspirin (81 mg/day) for preeclampsia risk. Ensure postpartum BP surveillance; annual BP if prior hypertensive pregnancy disorder. Brain health New emphasis on early treatment to reduce risk of cognitive decline/dementia; SBP goal <130 supported to protect brain health. Resistant HTN & devices Updated sections on resistant hypertension and renal denervation (selection, work-up, positioning in care pathway). Out-of-office measurement Home BP monitoring integrated into care pathways; avoid cuffless wearables for decision-making until accuracy improves. Lifestyle remains first-line Reinforced specifics: Na⁺ <2,300 mg/day (toward 1,500), weight loss ≥5% if overweight/obese, alcohol minimal/none, structured aerobic±resistance activity, stress-reduction. Severe hypertension (no acute TOD) >180/120 mm Hg without acute target-organ damage → expedited outpatient titration/initiation (not automatic admission). Therapeutic add-ons GLP-1 receptor agonists may be considered in overweight/obese patients to aid BP control and weight reduction—adjunct to standard classes. Team-based care & equity Strong push for multidisciplinary teams, single-pill combos, home BP protocols, and addressing social drivers to close control gaps. Primary sources (today, Aug 14–15, 2025 IST): ACC press release & summary; AHA “Top Things to Know” & guideline hub (with links to Circulation/Hypertension/JACC manuscripts).