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CLINICAL STATEMENTS AND GUIDELINES

Circulation. 2025;152:e114–e218. DOI: 10.1161/CIR.0000000000001356 September 16, 2025 e197

8.	 Zhang W, Zhang S, Deng Y, et al. Trial of intensive blood-pressure control in older patients with hypertension. N Engl J Med. 2021;385:1268–1279. 9.	 Rahimi K, Bidel Z, Nazarzadeh M, et al. Age-stratified and blood-pressurestratified effects of blood-pressure-lowering pharmacotherapy for the pre­ vention of cardiovascular disease and death: an individual participant-level data meta-analysis. Lancet. 2021;398:1053–1064. 10.	 Sundstrom J, Arima H, Jackson R, et al. Effects of blood pressure reduction in mild hypertension: a systematic review and meta-analysis. Ann Intern Med. 2015;162:184–191. 11.	 Blood Pressure Lowering Treatment Trialists Collaboration. Blood pressurelowering treatment based on cardiovascular risk: a meta-analysis of indi­ vidual patient data. Lancet. 2014;384:591–598. 12.	 Karmali KN, Lloyd-Jones DM, van der Leeuw J, et al. Blood pressurelowering treatment strategies based on cardiovascular risk versus blood pressure: a meta-analysis of individual participant data. PLoS Med. 2018;15:e1002538. 13.	 Khan SS, Coresh J, Pencina MJ, et al. Novel prediction equations for absolute risk assessment of total cardiovascular disease incorporating cardiovascular-kidney-metabolic health: a scientific statement from the American Heart Association. Circulation. 2023;148:1982–2004. 14.	 Khan SS, Matsushita K, Sang Y, et al. Development and validation of the American Heart Association’s PREVENT equations. Circulation. 2024;149:430–449. 15.	 Zinzuwadia AN, Mineeva O, Li C, et al. Tailoring risk prediction models to local populations. JAMA Cardiol. 2024;9:1018–1028. 16.	 Scheuermann B, Brown A, Colburn T, et al. External validation of the Ameri­ can Heart Association PREVENT cardiovascular disease risk equations. JAMA Network Open. 2024;7:e2438311-e2438311. 17.	 D’Agostino Sr RB, Vasan RS, Pencina MJ, et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008;117:743–753. 18.	 Muntner P, Carey RM, Gidding S, et al. Potential US population impact of the 2017 ACC/AHA high blood pressure guideline. Circulation. 2018;137:109– 118. 19.	 Fuchs SC, Poli-de-Figueiredo CE, Figueiredo Neto JA, et al. Effective­ ness of chlorthalidone plus amiloride for the prevention of hypertension: the PREVER-Prevention randomized clinical trial. J Am Heart Assoc. 2016;5:e004248. 20.	 Bao W, Threefoot SA, Srinivasan SR, et al. Essential hypertension predicted by tracking of elevated blood pressure from childhood to adulthood: the Bogalusa Heart Study. Am J Hypertens. 1995;8:657–665. 21.	 Chen V, Ning H, Allen N, et al. Lifetime risks for hypertension by contem­ porary guidelines in African American and White men and women. JAMA Cardiol. 2019;4:455–459. 22.	 Reges O, Ning H, Wilkins JT, et al. Association of cumulative systolic blood pressure with long-term risk of cardiovascular disease and healthy longev­ ity: findings from the lifetime risk pooling project cohorts. Hypertension. 2021;77:347–356. 23.	 Allen NB, Siddique J, Wilkins JT, et al. Blood pressure trajectories in early adulthood and subclinical atherosclerosis in middle age. JAMA. 2014;311:490–497. 24.	 Gidding SS, Liu K, Colangelo LA, et al. Longitudinal determinants of left ventricular mass and geometry: the Coronary Artery Risk Development in Young Adults (CARDIA) study. Circ Cardiovasc Imaging. 2013;6:769–775. 25.	 McEvoy JW, Martin SS, Dardari ZA, et al. Coronary artery calcium to guide a personalized risk-based approach to initiation and intensification of antihy­ pertensive therapy. Circulation. 2017;135:153–165. 26.	 Pandey A, Patel KV, Vongpatanasin W, et al. Incorporation of biomarkers into risk assessment for allocation of antihypertensive medication accord­ ing to the 2017 ACC/AHA high blood pressure guideline: a pooled cohort analysis. Circulation. 2019;140:2076–2088. 27.	 Haug EB, Horn J, Markovitz AR, et al. Association of conventional cardiovas­ cular risk factors with cardiovascular disease after hypertensive disorders of pregnancy: analysis of the Nord-Troendelag Health study. JAMA Cardiol. 2019;4:628–635. 28.	 Lloyd-Jones DM, Allen NB, Anderson CA, et al. Life’s essential 8: updating

and enhancing the American Heart Association’s construct of cardiovas­ cular health: a presidential advisory from the American Heart Association. Circulation. 2022;146:e18-e43.

5.2.3 Initial Medication Selection for Treatment of Pri­

mary Hypertension 1.	 Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering on

outcome incidence in hypertension: 4. Effects of various classes of antihy­ pertensive drugs-overview and meta-analyses. J Hypertens. 2015;33:195– 211. 2.	 Wei J, Galaviz KI, Kowalski AJ, et al. Comparison of cardiovascular

events among users of different classes of antihypertension medica­ tions: a systematic review and network meta-analysis. JAMA Netw Open. 2020;3:e1921618. 3.	 Fretheim A, Odgaard-Jensen J, Brors O, et al. Comparative effectiveness of antihypertensive medication for primary prevention of cardiovascular dis­ ease: systematic review and multiple treatments meta-analysis. BMC Med. 2012;10:33. 4.	 Czernichow S, Zanchetti A, Turnbull F, et al. The effects of blood pressure reduction and of different blood pressure-lowering regimens on major car­ diovascular events according to baseline blood pressure: meta-analysis of randomized trials. J Hypertens. 2011;29:4–16. 5.	 Law MR, Morris JK, Wald N. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised tri­ als in the context of expectations from prospective epidemiological studies. BMJ. 2009;338:b1665. 6.	 The Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensinconverting enzyme inhibitor or calcium channel blocker vs diuretic: the An­ tihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002;288:2981–2997. 7.	 Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure-lowering on outcome incidence in hypertension: 5. head-to-head comparisons of various classes of antihypertensive drugs - overview and meta-analyses. J Hypertens. 2015;33:1321–1341. 8.	 Law MR, Morris JK, Wald N. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised tri­ als in the context of expectations from prospective epidemiological studies. BMJ. 2009;338:. 9.	 Ishani A, Cushman WC, Leatherman SM, et al. Chlorthalidone vs. hydro­ chlorothiazide for hypertension-cardiovascular events. N Engl J Med. 2022;387:2401–2410. 10.	 Whelton PK, Carey RM, Aronow WS, et al. 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: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:1269– 1324. 11.	 Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint Na­

tional Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42:1206–1252.

5.2.4 Choice of Initial Monotherapy Versus Initial Combi­

nation Drug Therapy 1.	 Parati G, Kjeldsen S, Coca A, et al. Adherence to single-pill versus free-

equivalent combination therapy in hypertension: a systematic review and meta-analysis. Hypertension. 2021;77:692–705. 2.	 Wald DS, Law M, Morris JK, et al. Combination therapy versus monotherapy in reducing blood pressure: meta-analysis on 11 000 participants from 42 trials. Am J Med. 2009;122:290–300. 3.	 Wang N, Rueter P, Atkins E, et al. Efficacy and safety of low-dose triple and quadruple combination pills vs monotherapy, usual care, or placebo for the initial management of hypertension: a systematic review and meta-analysis. JAMA Cardiol. 2023;8:606–611. 4.	 Schmieder RE, Wassmann S, Predel HG, et al. Improved persistence to medication, decreased cardiovascular events and reduced all-cause mortal­ ity in hypertensive patients with use of single-pill combinations: results from the START-Study. Hypertension. 2023;80:1127–1135. 5.	 Verma AA, Khuu W, Tadrous M, et al. Fixed-dose combination antihyper­ tensive medications, adherence, and clinical outcomes: a population-based retrospective cohort study. PLoS Med. 2018;15:e1002584. 6.	 Webster R, Salam A, de Silva HA, et al. Fixed low-dose triple combination antihypertensive medication vs usual care for blood pressure control in pa­ tients with mild to moderate hypertension in Sri Lanka: a randomized clinical trial. JAMA. 2018;320:566–579. 7.	 Fried LF, Emanuele N, Zhang JH, et al. Combined angiotensin inhibition for the treatment of diabetic nephropathy. N Engl J Med. 2013;369:1892– 1903. 8.	 Parving HH, Brenner BM, McMurray JJ, et al. Cardiorenal end points in a trial of aliskiren for type 2 diabetes. N Engl J Med. 2012;367:2204–2213. 9.	 Investigators O, Yusuf S, Teo KK, et al. Telmisartan, ramipril, or both in pa­

tients at high risk for vascular events. N Engl J Med. 2008;358:1547–1559.

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