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REFLECTIONS
Hypertension
Hypertension Global Newsletter #10 2026

GUIDELINES AND SCIENTIFIC STATEMENTS Hypertension

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.
Jones DW, et al. Hypertension. 2025 Oct;82(10):e212-e316.

As the most prevalent modifiable risk factor for cardiovascular disease (CVD) worldwide, elevated blood pressure (BP) exacts a toll on global
public health. It rarely occurs in isolation, frequently compounding patient risk by co-existing with obesity, diabetes, and other metabolic
conditions. Despite decades of public health efforts and effective treatments, rates of awareness and control remain below target, often due to
significant age- and race-based disparities. Because hypertension drives an increase in major adverse cardiovascular events (MACEs), ranging
from heart failure (HF) to cognitive decline, early detection and consistent management are necessary to halt irreversible organ damage.

This 2025 multi-society guideline retires and replaces the previous 2017 guideline. A comprehensive, systematic literature search was
conducted between December 2023 and June 2024, after which a multidisciplinary writing committee of cardiologists, nephrologists,
internists, epidemiologists, and advanced practice nurses reviewed clinical trials, systematic reviews, and observational data involving
human subjects published since February 2015. They used this evidence to formulate updated recommendations, grading each clinical
strategy based on the strength of its benefit versus risk.

A major shift in this updated guideline is the transition to using the PREVENT (Predicting Risk of CVD EVENTs) calculator to estimate a
patient’s 10-year CV risk, replacing the older pooled cohort equations (PCEs). The committee determined that PREVENT is more effective
because it was derived from a highly diverse dataset of 3.2 million individuals, as opposed to the 25,000-person dataset from which the
PCEs were derived. PREVENT incorporates a larger age group of adults than PCEs, includes statin therapy as a predictor (whereas the
PCEs were only applicable to adults who were not on statin therapy), and uses metrics like kidney function and place-based social risk
to predict total CVD risk (including HF), rather than solely atherosclerotic events, like PCEs. In a sample of 3.3 million US adults, PCEs
overpredicted the risk approximately two-fold, while PREVENT had excellent calibration, even when examined by race and ethnic group.

Use of risk-based thresholds for initiation of BP treatment in adults

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