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CLINICAL STATEMENTS AND GUIDELINES September 16, 2025 Circulation. 2025;152:e114–e218. DOI: 10.1161/CIR.0000000000001356 e120 utmost clinical importance that merit formal systematic review to determine which patients are most likely to ben efit from a drug, device, or treatment strategy, and to what degree. Criteria for commissioning an evidence review committee and formal systematic review include absence of a current authoritative systematic review, feasibility of defining the benefit and risk in a time frame consistent with the writing of a guideline, relevance to a substantial number of patients, and likelihood that the findings can be translated into actionable recommendations. Evidence review committee members may include methodologists, epidemiologists, clinicians, and biostatisticians. Recom mendations developed by the writing committee on the basis of the systematic review are marked “SR”. Guideline-Directed Medical Therapy The term guideline-directed medical therapy (GDMT) en compasses clinical evaluation, diagnostic testing, and both pharmacological and procedural treatments. For these and all recommended drug treatment regimens, the reader should confirm dosage with product insert material and evaluate for contraindications and interactions. Recom mendations are limited to drugs, devices, and treatments approved for clinical use in the United States. Catherine M. Otto, MD, FACC, FAHA Chair, ACC/AHA Joint Committee on Clinical Practice Guidelines 1 INTRODUCTION 1.1 Methodology and Evidence Review The recommendations listed in this guideline are, when ever possible, evidence-based. An initial extensive evi dence review, which included literature derived from research involving human subjects, published in English, and indexed in MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Re search and Quality, and other selected databases rel evant to this guideline published from February 2015, was performed from December 2023 to June 2024. Key search words included but were not limited to the follow ing: ACC/AHA clinical practice guideline; antihyperten sive agents; antihypertensive response; blood pressure; blood pressure control; blood pressure determination; blood pressure monitoring; cardiovascular disease; dos age; hypertension; risk factors; and time factors. Additional relevant studies, which were published through January 2025 during the guideline writing pro cess, were also considered by the writing committee and added to the evidence tables when appropriate. The evidence tables summarize the evidence used by the writ ing committee to formulate recommendations and are available online. References selected and published in the present document are representative and not all-inclusive. 1.2 Organization of the Writing Committee The writing committee consisted of general/preventive cardiologists, interventional cardiologists, cardiac imaging experts, nephrologists, internists, a neurologist, a geron tologist, cardiovascular epidemiologists, advanced prac tice nurses, a clinical pharmacist, a physician associate, and a patient advocate. The writing committee included representatives from the AHA, ACC, Association of Black Cardiologists (ABC), American Academy of Physician As sociates (AAPA), American College of Clinical Pharmacy (ACCP), Society of General Internal Medicine (SGIM), Preventive Cardiovascular Nurses Association (PCNA), American Medical Association (AMA), American Asso ciation of Nurse Practitioners (AANP), National Medical Association (NMA), American College of Preventive Medi cine (ACPM), American Society of Preventive Cardiology (ASPC), and the American Geriatrics Society (AGS). Ap pendix 1 of the current document lists writing committee members’ comprehensive and relevant RWI. On February 28, 2024, a writing committee member disclosed relationships with Amgen and Novartis, which were deemed to be relevant to the guideline. The mem ber was removed before the guideline writing committee reviewed and approved the manuscript for submission to the Joint Committee, the AHA Science Advisory and Coordinating Committee, the AHA Executive Commit tee, the ACC Clinical Policy and Approval Committee, the ACC Science and Quality Committee, and the collaborat ing organizations for consideration of endorsement. 1.3 Guideline Review and Approval The Joint Committee appointed a peer review committee to review the document. The peer review committee com prised individuals nominated by the ACC, AHA, and the col laborating organizations. Reviewers’ RWI information was distributed to the writing committee and is published in this document (Appendix 2). This document was approved for publication by the governing bodies of the ACC and the AHA and was endorsed by the ABC, AAPA, ACCP, SGIM, PCNA, AMA, AANP, NMA, ACPM, ASPC, and AGS. 1.4 Scope of the Guideline This guideline is intended to be a resource for clinical and public health professionals. Clinicians should be ad vised that this guideline retires and replaces the previously published “2017 ACC/AHA/AAPA/ABC/ACPM/AGS/ APhA/ASH/ASPC/NMA/PCNA Guideline for the Pre vention, Detection, Evaluation, and Management of High Blood Pressure in Adults.” This guideline does not provide recommendations on blood pressure (BP) prevention and management in patient populations with these conditions: chronic coronary disease (CCD), heart failure (HF), atrial fibrillation (AF), valvular heart disease, aortic disease (AD), Downloaded from http://ahajournals.org by on October 7, 2026