ACC-AHA 2025 2025 AHA/ACC High Blood Pressure Guideline
ACC/AHA｜循環器 / 高血圧 / 予防｜105 ページ｜チャンク 1039｜推奨 16 件｜current
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| p.26 | 1 A | angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) may stimulate renin and suppress aldosterone4; thiazidetype, loop diuretics, MRA, and potassium-sparing diuretics can stimulate both renin and aldosterone.4 Throughout this guideline, we use the term thiazidetype diuretic to collectively refer to hydrochloro thiazide (HCTZ), chlorthalidone, and indapamide. Although the literature traditionally differentiates these medications based on their chemical struc tures, categorizing HCTZ as a thiazide-type diuretic because it possesses a benzothiadiazine ring and categorizing chlorthalidone and indapamide as thiazide-like diuretics because they lack this ring (yet remain closely related sulfonamide deriva tives), the interchangeability of thiazide-type and -like agents remains a debated topic. For simplic ity and to minimize confusion, in this guideline we have chosen to group them under a single term. In most settings, it is acceptable for clinicians to choose among these agents for treatment. We rec ognize that there are differences in potency and half-life between these agents that may be relevant in some situations, particularly in the management of resistant hypertension (Section 5.6, “Resistant Hypertension”). Initial screening for primary aldo steronism can typically be interpreted in the con text of most medications that affect renin and aldosterone. If screening results are negative or borderline in patients in whom there is a high level of suspicion for primary aldosteronism and confir mation of the diagnosis will change management, potentially interfering medications may be tempo rarily substituted with noninterfering medications (ie, nondihydropyridine calcium channel blockers [CCBs], vasodilators, peripheral alpha-blockers, and potentially dihydropyridine CCB21) for at least 2 to 4 weeks prior to repeat testing. 5. The diagnosis of primary aldosteronism may require Downloaded from http://ahajournals.org by on October 7, 2026 | ||
| p.28 | 1 A | from the HIPARCO-2 (Long-Term Effect of CPAP on BP in Patients With Resistant Hypertension) study demonstrate that participants with OSA and resistant hypertension adherent to CPAP therapy (≥4 hours/night) compared with nonadherent CPAP participants had statistically significant decreases in mean 24-hour ABPM, including nighttime SBP and DBP (−5.5 and −4.9 mm Hg, respectively) over a 59-month follow-up period.16 4 PREVENTION STRATEGIES Synopsis | ||
| p.28 | 1 A | The etiology of primary (previously termed essential) hypertension is a complex interplay of genetics, lifestyle choices, and chronic stress. Even in those with a genetic predisposition to hypertension, healthy lifestyle behav iors can prevent hypertension. All of the therapies rec ommended for the treatment of hypertension in Section 5.1 (“Lifestyle and Psychosocial Approaches”) are useful in primordial prevention of hypertension and should be encouraged.1 These include weight loss for those with overweight or obesity; a heart-healthy diet such as the DASH (Dietary Approaches to Stop Hypertension) eat ing plan; no more than 2300 mg of sodium per day (with the ideal limit of no more than 1500 mg per day for most adults); dietary potassium 3500 to 5000 mg per day; aerobic and resistance exercise (≥150 minutes of mod erate physical activity per week and resistance exercise ≥2 days per week); and stress management practices. Intake of any alcohol is associated with higher SBP in a dose-response manner, including in individuals without hypertension.2 Downloaded from http://ahajournals.org by on October 7, 2026 5 BP MANAGEMENT 5.1 Lifestyle and Psychosocial Approaches | ||
| p.32 | 1 A | 5.2 Medical Management Synopsis | ||
| p.32 | 1 A | Throughout this guideline, we use the term thi azide-type diuretic to collectively refer to HCTZ, chlorthalidone, and indapamide. Although the literature traditionally differentiates these medications based on their chemical structures, categorizing HCTZ as a thiazide-type diuretic because it possesses a benzo thiadiazine ring and categorizing chlorthalidone and indapamide as thiazide-like diuretics because they lack this ring (yet remain closely related sulfonamide derivatives), the interchangeability of thiazide-type and -like agents remains a debated topic. For simplicity and to minimize confusion, in this guideline we have chosen to group them under a single term. In most settings, it is acceptable for clinicians to choose among these agents for treatment. We recognize there are differ ences in potency and half-life between these agents that may be relevant in some situations, particularly in the management of resistant hypertension (Section 5.6, “Resistant Hypertension”). In that setting, thiazidelike diuretics are preferred due to their greater efficacy; therefore, treatment recommendations in this setting continue to advocate thiazide-like diuretics. | ||
| p.33 | 1 A | CLINICAL STATEMENTS AND GUIDELINES | ||
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| p.46 | 1 A | systems, including the heart, vasculature, kidneys, brain, and retina due to hypertension.1,2 Common forms of target organ damage include left ventricular hyper trophy, HF, subclinical and clinical atherosclerosis, CKD (ie, reduced eGFR or albuminuria), and cerebrovascular disease (eg, stroke, dementia, retinopathy).3 Numerous studies demonstrate an association between hyperten sion and target organ damage,4–9 and longitudinal data indicate at least 1 form of hypertension-related target organ damage is present in >50% of individuals with hypertension.1 Recent studies also demonstrate rela tionships between the severity of hypertension and the number of organs affected by hypertension,10 as well as the number of affected organs and increased CVD risk.11 Although there are strong data linking hyper tension to target organ damage, recommendations on screening and management of different types of tar get organ damage beyond hypertension treatment are lacking.12 The goals of preventing target organ damage and its progression from asymptomatic to symptomatic target organ damage can be achieved by focusing on hypertension control.13 Future studies are needed to inform how hypertension-related target organ damage should be diagnosed and managed among patients with hypertension. | ||
| p.50 | 1 A | There are no recommendations based on sufficient ly strong evidence for the management of adults with hypertension and valvular heart disease other than for aortic stenosis or chronic aortic regurgitation.1 Uncon trolled hypertension among individuals with moderate to severe aortic stenosis and/or aortic regurgitation is as sociated with worsening symptoms, HFrEF, and death.2–5 Data support the use of antihypertensive medications to control BP in adults with aortic stenosis and/or chronic aortic regurgitation and hypertension. Among adults with severe aortic stenosis who have undergone transcath eter aortic valve implantation, the use of ACEi or ARB to achieve BP control is associated with reduced mortality.6 However, there are no data from RCTs that examined op timal BP targets for adults with hypertension and chronic aortic regurgitation. Chronic aortic regurgitation is often accompanied by a wide pulse pressure, and medications that lower heart rate may paradoxically increase SBP.7,8 The use of ACEi and ARB in adults with chronic mod erate to severe aortic regurgitation and hypertension is associated with reductions in cardiovascular events and lower all-cause mortality.9 For additional information on the management of aortic stenosis and chronic aortic re gurgitation and mitral regurgitation, including indications for appropriate consultation or referral to a primary or comprehensive Heart Valve Center, see Sections 3, 4.3, and 2.6 in the “2020 ACC/AHA Guideline for the Man agement of Patients With Valvular Heart Disease.”1 | ||
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| p.58 | 1 A | Downloaded from http://ahajournals.org by on October 7, 2026 6 Health systems are developing and using patient registries and EHRs for large-scale queries to sup port population health management strategies by identifying undiagnosed or uncontrolled hyperten sion as ongoing quality improvement initiatives.17 Multifaceted approaches studied to date include: 1) application of hypertension screening algorithms to EHR databases to identify at-risk patients; 2) contacting at-risk patients to schedule BP mea surements; 3) monthly feedback to clinicians about at-risk patients who have yet to complete a BP measurement; and 4) electronic prompts for BP measurements whenever at-risk patients visit the clinic. The role of the EHR is paramount in support ing interventions in primary care and to maximize hypertension management in under-represented racial and ethnic groups. Some clinical interven tions implementing clinical decision support sys tems and best practice alert applications in primary care clinics show promising results.15 |