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CLINICAL STATEMENTS AND GUIDELINES September 16, 2025 Circulation. 2025;152:e114–e218. DOI: 10.1161/CIR.0000000000001356 e128 no longer used in clinical practice due to regulatory issues with use of mercury. The use of auscultatory measurements with an aneroid device is a suitable alternative but requires regular device recalibration.5 Additional potential limitations to the auscultatory method include improper stethoscope placement, inappropriately fast cuff deflation rate, digit prefer ence, and observer hearing deficits.2,3 As long as a standardized protocol is followed and the oscil lometric device has been rigorously validated, the use of an oscillometric device over the auscultatory method is reasonable.4,5 Oscillometric device valida tion has been typically done among individuals in sinus rhythm; however, evidence from validation stud ies of these devices among individuals in AF is lim ited.15 Oscillometric devices should be recalibrated on an ongoing basis per the manufacturer’s guid ance. Mean unattended AOBP is lower than mean office BP obtained with a clinician present and using a standardized protocol.6 Further, although there is no between-group difference in mean unattended AOBP and mean out-of-office BP,16,17 there can be large within-person differences between these 2 BP measurements.6 Among the few available RCTs, there were typically no differences between unattended AOBP versus AOBP measured with a clinician pres ent while using a standardized protocol.6,18,19 3.1.2 Patient Evaluation, Including Laboratory Tests and Other Diagnostic Procedures Recommendation for Laboratory Tests and Other Diagnostic Procedures COR LOE Recommendation 1 C-EO 1. For adults who are diagnosed with hypertension, laboratory tests (ie, complete blood count, serum electrolytes, serum creatinine, lipid profile, glucose or hemoglobin A1c [HbA1c], thyroid-stimulating hormone, urinalysis, and urine albumin-to-creatinine ratio) and diagnostic procedures (12-lead ECG) should be performed to optimize management. Synopsis When a new diagnosis of hypertension is suspected or confirmed, a comprehensive medical history, physical examination, laboratory tests, and other diagnostic proce dures should be performed as part of the standard evalu ation of a patient. The primary goal of this evaluation is to inform the need for and optimal choice of GDMT for BP lowering. Further, this evaluation is useful for the identi fication of contributing causes of elevated BP, including secondary causes (Section 3.2.3, “Secondary Forms of Hypertension”), estimation of predicted cardiovascular risk, and evaluation for the presence and extent of tar get organ damage (eg, impaired kidney function, albu minuria).1 Basic laboratory testing should be repeated in patients with hypertension at least annually, or sooner if clinical evidence of glucose intolerance, electrolyte im balances, or uric acid changes is noted. Baseline test ing is needed for monitoring of serum electrolytes and serial assessments of kidney function and CVD risk. In addition to the standard diagnostic assessment, optional testing for cardiac biomarkers (eg, high-sensitivity tropo nin [hs-cTn], B-type natriuretic peptide [BNP]2), echocar diography, and coronary artery calcium may be helpful for CVD risk stratification and for detection of target organ damage in individuals with hypertension. Additional di agnostic evaluation should be considered when second ary causes of hypertension are suspected (Section 3.2.3, “Secondary Forms of Hypertension”). Recommendation-Specific Supportive Text 1 In adults with a new diagnosis of hypertension, a comprehensive medical history, physical examination, and routine laboratory testing (Table 6) are useful to establish baseline CVD risk and inform manage ment decisions, including the need for additional test ing. Pertinent laboratory tests should be repeated at least annually to monitor for potential adverse effects of therapies (eg, serum electrolytes), to assess for development or progression of kidney disease (eg, urine albumin-to-creatinine ratio,1 creatinine-based or cystatin-C based estimated glomerular filtration rate [eGFR]), and to monitor for changes in predicted CVD risk (eg, lipid profile). Electrocardiography can provide important information on subclinical CVD (eg, left ventricular hypertrophy), and cardiac biomarkers, echocardiography, and coronary artery calcium scor ing allow more refined risk estimation for CVD and assessment of the prevalence and extent of subclini cal CVD.2,3 3.1.3 Out-of-Office BP Monitoring Synopsis Hypertension screening and management, includ ing the use of BP targets, have primarily relied on BP measured in the office setting. Out-of-office Table 6. Routine Laboratory Testing for New Diagnosis of Hypertension Diagnostic Tests Complete blood count Serum sodium, potassium, calcium Serum creatinine with estimation of glomerular filtration rate (based on the 2021 CKD-EPI Creatinine Equation) Lipid profile Fasting blood glucose or Hemoglobin A1c Thyroid-stimulating hormone Urinalysis Urine albumin-to-creatinine ratio; urine protein-to-creatinine ratio ECG Modified with permission from Whelton et al.4 Copyright 2018 American Col lege of Cardiology Foundation and American Heart Association, Inc. ECG indicates electrocardiogram. Downloaded from http://ahajournals.org by on October 7, 2026