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CLINICAL STATEMENTS AND GUIDELINES September 16, 2025 Circulation. 2025;152:e114–e218. DOI: 10.1161/CIR.0000000000001356 e116 5.5.2. Preeclampsia and Eclampsia, Including Preeclampsia Superimposed on Chronic Hypertension. . . . . . . . . . . . . . . . . . e174 5.5.3. Short- and Long-Term Follow- Up of Pregnancy-Associated Hypertension. . . . . . . . . . . . . . . . . . e175 5.6. Resistant Hypertension and Renal Denervation. . . . . . . . . . . . . . . . . . . . . e176 6. Complications of Management. . . . . . . . . . . . . . . e179 6.1. Management of OH . . . . . . . . . . . . . . . . . . . e179 6.2. Hypertensive Emergencies and Severe Hypertension in Nonpregnant and Nonstroke Patients. . . . . . . . . . . . . . . . e180 6.2.1. Medications for Hypertensive Emergencies. . . . . . . . . . . . . . . . . . . e181 6.3. Sexual Dysfunction. . . . . . . . . . . . . . . . . . . . e181 6.4. Patients Scheduled for Surgical Procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . e183 7. Evidence Gaps and Future Directions. . . . . . . . . e186 Key Words. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e115 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e188 WHAT IS NEW Table 1 highlights new and/or substantially revised practice-changing recommendations since the last itera tion of the guideline and is not a comprehensive list of all updates. Some of these recommendations have cor responding footnotes not captured in this table. TOP TAKE-HOME MESSAGES 1 High blood pressure is the most prevalent and modifi able risk factor for the development of cardiovascu lar diseases, including coronary artery disease, heart failure, atrial fibrillation, stroke, dementia, chronic kid ney disease, and all-cause mortality. The overarching blood pressure treatment goal is <130/80 mm Hg for all adults, with additional considerations for those who require institutional care, have a limited predicted lifespan, or are pregnant. 2. Clinicians should collaborate with community leaders, health systems, and practices to imple ment screening of all adults in their communities and implement guideline-based recommendations regarding prevention and management of high blood pressure to improve rates of blood pressure control. 3. Multidisciplinary team-based care is effective in assessing and addressing patient access to medi cations and other structural barriers to support indi vidual patient needs and thereby reduce barriers to achieving hypertension control. Team members may include physicians, pharmacists, nurse prac titioners, nurses, physician assistants/associates, dieticians, community health workers, and other health care professionals. 4. Blood pressure is classified by the following frame work: normal blood pressure is defined as <120 mm Hg systolic and <80 mm Hg diastolic; elevated blood pressure as 120 to 129 mm Hg systolic and <80 mm Hg diastolic; stage 1 hypertension as 130 to 139 mm Hg systolic or 80 to 89 mm Hg dia stolic; and stage 2 hypertension as ≥140 mm Hg systolic or ≥90 mm Hg diastolic. 5. For all adults, lifestyle changes, including maintain ing or achieving a healthy weight, following a hearthealthy eating pattern (such as DASH [Dietary Approaches to Stop Hypertension]), reducing sodium intake, increasing dietary potassium intake, adopting a moderate physical activity program, managing stress, and reducing or eliminating alco hol intake are strongly recommended to prevent or treat elevated blood pressure and hypertension. 6. Initiation of medication therapy to lower blood pres sure in addition to lifestyle interventions is recom mended for all adults with average blood pressure ≥140/90 mm Hg and/or for selected adults with average blood pressure ≥130/80 mm Hg who have clinical cardiovascular disease, previous stroke, dia betes, chronic kidney disease, or increased 10-year predicted cardiovascular risk of ≥7.5% defined by PREVENTTM (Predicting Risk of CVD EVENTs). 7. In adults with average blood pressure ≥130/80 mm Hg and at lower 10-year cardiovascular dis ease risk defined by PREVENT of <7.5%, initiation of medication therapy to lower blood pressure is recommended if average blood pressure remains ≥130/80 mm Hg after an initial 3- to 6-month trial of lifestyle modification. 8. For all adults with stage 2 hypertension, the initia tion of antihypertensive drug therapy with 2 firstline agents of different classes in a single-pill, fixed-dose combination is preferred over 2 sepa rate pills to improve adherence and reduce time to achieve blood pressure control. 9. Home blood pressure monitoring combined with fre quent interactions with multidisciplinary team mem bers using standardized measurement and treatment protocols and home measurement protocols is an important integrated tool to improve rates of blood pressure control. Reliance on cuffless devices, including smartwatches, for accurate blood pressure measurements should be avoided until these devices demonstrate greater precision and reliability. 10. Severe hypertension in nonpregnant individuals, defined as blood pressure >180/120 mm Hg, with out evidence of acute target organ damage, should be evaluated and treated in the outpatient setting with initiation, reinstitution, or intensification of oral antihy pertensive medications in a timely manner. Downloaded from http://ahajournals.org by on October 7, 2026