p.5 抽出テキスト

CLINICAL STATEMENTS AND GUIDELINES

September 16, 2025 Circulation. 2025;152:e114–e218. DOI: 10.1161/CIR.0000000000001356 e118

New or Revised Section Title 2017 Recommendation 2025 Recommendation Revised recommendation 5.3.9.1 Acute Intracerebral Hemorrhage COR 2a: In adults with ICH who present with SBP >220 mm Hg, it is reasonable to use con­ tinuous intravenous drug infusion and close BP monitoring to lower SBP. COR 2a: In adults with acute spontaneous ICH requiring acute BP lowering, careful titration to ensure smooth, nonlabile, and sustained control of BP, avoiding peaks and large variability in SBP, can be beneficial for improving functional outcomes. New recommendation 5.3.9.2. Acute Ischemic Stroke N/A COR 3 Harm: In patients undergoing success­ ful brain reperfusion with endovascular treat­ ment for a large vessel occlusion, lowering SBP <140 mm Hg within the first 24 to 72 hours after reperfusion can worsen long-term func­ tional outcome. Revised recommendation 5.3.9.4 Mild Cognitive Impair­ ment and Dementia COR 2a: In adults with hypertension, BP lower­ ing is reasonable to prevent cognitive decline and dementia. COR 1: In adults with hypertension, a goal of <130 mm Hg SBP is recommended to prevent mild cognitive impairment and dementia. New recommendation 5.5. Hypertension and Preg­ nancy N/A COR 1: Pregnant individuals with SBP ≥160 mm Hg or DBP ≥110 mm Hg confirmed on repeat measurement within 15 minutes should receive antihypertensive medication to lower BP to <160/<110 mm Hg within 30 to 60 minutes to prevent adverse events. New recommendation 5.5. Hypertension and Preg­ nancy N/A COR 1: Pregnant individuals with chronic hypertension (defined as prepregnancy hyper­ tension or SBP 140-159 mm Hg and/or DBP 90-109 mm Hg prior to 20 weeks gestation) should receive antihypertensive therapy to achieve BP <140/90 mm Hg to prevent mater­ nal and perinatal morbidity and mortality. New recommendation 5.5. Hypertension and Preg­ nancy N/A COR 1: Individuals with hypertension who are planning a pregnancy or who become pregnant should be counseled about the benefits of lowdose aspirin to reduce the risk of preeclampsia and its sequelae. Revised recommen­ dation 5.5 Hypertension and Preg­ nancy COR 3 harm: Women with hypertension who be­ come pregnant should not be treated with ACEi or direct renin inhibitors. COR 3 Harm: Individuals with hypertension who are planning a pregnancy or who become pregnant should not be treated with atenolol, ACEi, ARB, direct renin inhibitors, nitroprusside, or MRA to avoid fetal harm. New recommendation 5.6. Resistant Hypertension and Renal Denervation N/A COR 1: In adults with resistant hypertension, a more detailed evaluation for secondary causes, to include careful review of all medications and removal of those with interfering effects on BP, is beneficial for lowering BP and simplifying treatment. New recommendation 5.6. Resistant Hypertension and Renal Denervation N/A COR 1: All patients with hypertension who are being considered for RDN should be evaluated by a multidisciplinary team with expertise in re­ sistant hypertension and RDN. New recommendation 5.6. Resistant Hypertension and Renal Denervation N/A COR 1: For patients with hypertension for whom RDN is contemplated, the benefits of lowering BP and potential procedural risks com­ pared with continuing medical therapy should be discussed as part of a shared decisionmaking process to ensure patients choose the therapy that meets their expectations. New recommendation 6.2. Hypertensive Emergencies and Severe Hypertension for Nonpregnant and Nonstroke Patients N/A COR 3 Harm: For adults with severe hyperten­ sion (>180/120 mm Hg) who are hospitalized for noncardiac conditions without evidence of acute target organ damage, intermittent use of additional intravenous or oral antihypertensive medications are not recommended to acutely reduce BP. ACEi indicates angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker, BP, blood pressure; CKD, chronic kidney disease; COR, Class of Recom­ mendation; CVD, cardiovascular disease; DBP, diastolic blood pressure; eGFR, estimated glomerular filtration rate; ICH, intracerebral hemorrhage; MRA, mineralocorti­ coid receptor antagonist; PREVENT = Predicting Risk of CVD EVENTs; RAASi, renin-angiotensin-aldosterone system inhibitor; RDN, renal denervation; and SBP, systolic blood pressure.

Table 1.  Continued

Downloaded from http://ahajournals.org by on October 7, 2026