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CLINICAL STATEMENTS AND GUIDELINES

Circulation. 2025;152:e114–e218. DOI: 10.1161/CIR.0000000000001356 September 16, 2025 e115

AIM: The “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” retires and replaces the “2017 ACC/ AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults.” METHODS: A comprehensive literature search was conducted from December 2023 to June 2024 to identify clinical studies, reviews, and other evidence performed on human subjects that were published since February 2015 in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE: The focus of this clinical practice guideline is to create a living, working document updating current knowledge in the field of high blood pressure aimed at all practicing primary care and specialty clinicians who manage patients with hypertension.

Key Words: AHA Scientific Statements ◼ antihypertensive agents ◼ antihypertensive response ◼ blood pressure ◼ blood pressure control ◼ blood pressure determination ◼ blood pressure monitoring ◼ cardiovascular disease ◼ dosage ◼ evaluation ◼ hypertension ◼ lifestyle

◼ major adverse cardiovascular events ◼ patient care team ◼ quality of life ◼ risk factors ◼ time factors

TABLE OF CONTENTS

Abstract. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e114 What Is New. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e116 Top Take-Home Messages. . . . . . . . . . . . . . . . . . . . . . . e116 Preamble. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e119 1.	 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e120 1.1. Methodology and Evidence Review. . . . . e120 1.2. Organization of the Writing Committee. . . . e120 1.3. Guideline Review and Approval. . . . . . . . . e120 1.4. Scope of the Guideline. . . . . . . . . . . . . . . . . e120 1.5. Class of Recommendations and Level of Evidence. . . . . . . . . . . . . . . . . . . . . . e122 1.6. Abbreviations. . . . . . . . . . . . . . . . . . . . . . . . . . e122 2.	 Definitions and Classification of BP. . . . . . . . . . . e124 2.1. Definition of High BP. . . . . . . . . . . . . . . . . . e124 3.	 Evaluation and Diagnosis . . . . . . . . . . . . . . . . . . . . e124

3.1 Patient Evaluation. . . . . . . . . . . . . . . . . . . . . e126 3.1.1.	 Accurate Measurement of

In-Office BP. . . . . . . . . . . . . . . . . . . e126 3.1.2.	 Patient Evaluation, Including

Laboratory Tests and Other Diagnostic Procedures. . . . . . . . . . e128 3.1.3.	 Out-of-Office BP Monitoring. . . . e128 3.1.4.	 ABPM and HBPM. . . . . . . . . . . . . e129 3.2. Patient Diagnosis. . . . . . . . . . . . . . . . . . . . . . e131 3.2.1.	 Causes of Hypertension. . . . . . . . e131 3.2.2.	 White-Coat Hypertension and

Masked Hypertension, and White-Coat Effect and Masked Uncontrolled Hypertension. . . . . . e131 3.2.3.	 Secondary Forms of

Hypertension. . . . . . . . . . . . . . . . . . e133 4.	 Prevention Strategies. . . . . . . . . . . . . . . . . . . . . . . . e141 5.	 BP Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . e141

5.1. Lifestyle and Psychosocial Approaches. . . . . . . . . . . . . . . . . . . . . . . . . . . e141 5.2. Medical Management. . . . . . . . . . . . . . . . . . e145 5.2.1 Initiation of Pharmacological

BP Treatment in the Context of Overall CVD Risk. . . . . . . . . . . . e145 5.2.2.	 BP Treatment Threshold and

the Use of CVD Risk Estimation to Guide Drug Treatment of Hypertension. . . . . . . . . . . . . . . . . . e145 5.2.3.	 Initial Medication Selection

for Treatment of Primary Hypertension. . . . . . . . . . . . . . . . . . e149 5.2.4.	 Choice of Initial Monotherapy

Versus Initial Combination Drug Therapy. . . . . . . . . . . . . . . . . . e149 5.2.5.	 Antihypertensive Medication

Adherence Strategies. . . . . . . . . . e153 5.2.6.	 Medication Interactions. . . . . . . . . e154 5.2.7. BP Goal for Patients With Hypertension. . . . . . . . . . . . . . . . . . e154 5.2.8.	 Electrolyte Imbalances. . . . . . . . . . e157 5.2.9.	 Kidney Dysfunction/Injury. . . . . . e158 5.3. Comorbidities. . . . . . . . . . . . . . . . . . . . . . . . . e158 5.3.1.	 Diabetes. . . . . . . . . . . . . . . . . . . . . . . e159 5.3.2.	 Obesity and Metabolic

Syndrome. . . . . . . . . . . . . . . . . . . . . . e160 5.3.3.	 Chronic Coronary Disease. . . . . . e161 5.3.4.	 Prevention of HF in Adults With Hypertension. . . . . . . . . . . . . . e161 5.3.5.	 Atrial Fibrillation. . . . . . . . . . . . . . . . e162 5.3.6.	 Valvular Heart Disease. . . . . . . . . . e163 5.3.7. Aortic Disease. . . . . . . . . . . . . . . . . e163 5.3.8.	 Hypertension Treatment in Patients With CKD. . . . . . . . . . . . . e163 5.3.9.	 Cerebrovascular Disease. . . . . . . e164 5.3.10.	Peripheral Artery Disease. . . . . . . e168 5.4. Plan of Care for Hypertension. . . . . . . . . . e169 5.5. Hypertension and Pregnancy. . . . . . . . . . . e171 5.5.1.	 Gestational Hypertension. . . . . . . e174

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