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CLINICAL STATEMENTS AND GUIDELINES September 16, 2025 Circulation. 2025;152:e114–e218. DOI: 10.1161/CIR.0000000000001356 e126 risk for total CVD, coronary heart disease, HF, aortic and peripheral vascular disease, kidney disease, isch emic and hemorrhagic stroke, dementia, and cognitive impairment.12–16 Relative risks for CVD associated with BP attenuate somewhat, but absolute CVD rates are substantially higher at older compared with younger ages.11,13 Among middle-aged and older adults, the prevalence and risks associated with higher SBP are greater than those associated with higher DBP.11,13 Once BP is above normal (SBP ≥120 mm Hg or DBP ≥80 mm Hg), there may be irreversible vascular damage and residual risk, even if antihypertensive treatment is started.17,18 Individuals with a diagnosis of hypertension who have treated SBP/DBP levels <120/80 mm Hg have twice the risk for CVD of adults without hyperten sion who have untreated SBP/DBP levels <120/80 mm Hg,17,18 highlighting the importance of primordial prevention of BP elevation. 3.1 Patient Evaluation 3.1.1 Accurate Measurement of In-Office BP Recommendations for Accurate Measurement of In-Office BP COR LOE Recommendations 1 C-LD 1. When diagnosing and managing high BP in adults, standardized methods are recommended for the accurate measurement and documentation of in-office BP (Figure 3).1–3 2a C-EO 2 When measuring in-office BP in adults, it is reasonable to use the oscillometric method with an automated device over the auscultatory method. Synopsis Historically, the measurement of BP in the office setting was performed by using auscultatory BP measurements using a calibrated mercury column, which was later re placed by auscultatory measurements using a nonmercury Figure 2. Estimated 10-Year Risks for Total Cardiovascular Disease Using the PREVENTTM CVD Risk Equations, Stratified by Blood Pressure Levels With Selected Combinations of Risk Factors. CVD indicates cardiovascular disease; eGFR, estimated glomerular filtration rate; and HDL, high-density lipoprotein. Derived from Khan et al19,20 via PREVENT. Downloaded from http://ahajournals.org by on October 7, 2026