Conversations about the best way to manage hypertension will be spurred by new Am Coll of Cardiology/Am Heart Assn guidelines.
Almost half of adults in the US have hypertension...or a BP of 130/80 mm Hg or higher. Be relieved that BP categories haven’t changed.
Tailor BP goals. For most patients, aim for a goal of less than 130/80, and encourage a goal of less than 120/80 if practical.
But this may not be safe for everyone. For example, consider a looser goal of less than 140/90, or even 150/90, for those with limited life expectancy or in a long-term care facility due to frailty.
Use this summary and your clinical judgment to treat high BP.
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Blood Pressure (mm Hg) |
ACC/AHA Guideline Treatment Recommendations |
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Normal: |
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Elevated: |
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Stage 1 hypertension: 130 - 139/80 - 89 |
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Stage 2 hypertension: ≥140/90 |
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*Am Heart Assn’s Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) calculator – see next article for details
**Consider 1 BP med if patients are at high risk of hypotension-related adverse effects (advanced age, etc) and titrate prn
Start with BP meds that improve outcomes...thiazides, ACEIs or ARBs, or long-acting dihydropyridine calcium channel blockers (amlodipine, etc).
Use a generic single-pill combo for most patients with stage 2 hypertension...if you don’t already. Most patients will need more than 1 med...and using combos may help boost adherence and offset side effects.
For instance, an ACEI or ARB may counteract peripheral edema due to CCBs...or an ACEI or ARB may reduce risk of hypokalemia due to a thiazide.
Expect to see single-pill combo Widaplik (telmisartan/amlodipine/indapamide) touted to improve adherence later this year, but cost may be a barrier.
Encourage home BP monitoring with a properly sized arm monitor validated for accuracy...to evaluate BP control and limit overtreatment. For example, watch BP closely for patients with significant weight reduction or improved exercise. They may need lower BP med doses.
Prepare to check for primary aldosteronism more often, such as for all patients with resistant hypertension. Stay tuned for more info on screening and treating primary hyperaldosteronism.
See our Treatment of Hypertension algorithm to guide med choice.
- Jones DW, Ferdinand KC, Taler SJ, et al. 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2025 Sep 16;152(11):e114-e218.
- Khan SS, Coresh J, Pencina MJ, et al; American Heart Association. Novel Prediction Equations for Absolute Risk Assessment of Total Cardiovascular Disease Incorporating Cardiovascular-Kidney-Metabolic Health: A Scientific Statement From the American Heart Association. Circulation. 2023 Dec 12;148(24):1982-2004.
- American Diabetes Association Professional Practice Committee. 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes-2025. Diabetes Care. 2025 Jan 1;48(1 Suppl 1):S207-S238.
- Algorithm: Treatment of Hypertension
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Chart:
Hypertension Goals in Adults
- Chart: Meds That Can Increase Blood Pressure