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CLINICAL STATEMENTS AND GUIDELINES

Circulation. 2025;152:e114–e218. DOI: 10.1161/CIR.0000000000001356 September 16, 2025 e125

decline thereafter.4 Among middle-aged individuals, the remaining lifetime risks for incident hypertension are as high as 80% to 90%, with earlier onset among men compared with women, and for Black and His­ panic compared with White and Chinese Americans.5–7 Current rates of awareness, treatment, and control of hypertension remain far below target levels for all groups and demonstrate important age- and racebased disparities (Figure 1).3

Hypertension frequently co-occurs with other CVD risk factors.8 From 2017 to 2020, 16.6% of adults with hypertension in the United States were current smokers, 72.6% were overweight or obese, 12.3% had diabetes, and 13.4% had diagnosed CKD,9 leading to additive and synergistic risks for CVD (Figure 2).10 BP is associated with fatal and nonfatal cardiovascular events in a graded, log-linear fashion, with an approxi­ mate doubling of risk for each 20-mm Hg higher SBP and 10-mm Hg higher DBP level.11 Among indi­ viduals without major risk factors, relative CVD event rates increase, starting at SBP levels as low as 90 mm Hg.12,13 Higher BP is associated with an elevated

Figure 1. Rates of Awareness, Treatment, and Control of Hypertension Among US Adults Aged 18 to 80 Years, 2017 to 2020*. *Missing data points indicate uncertain estimates due to small sample sizes for that subgroup. NH indicates non-Hispanic. Derived from NHANES.9

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