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CLINICAL STATEMENTS AND GUIDELINES

September 16, 2025 Circulation. 2025;152:e114–e218. DOI: 10.1161/CIR.0000000000001356 e200

6 Persu A, De Plaen JF. Recent insights in the development of organ damage

caused by hypertension. Acta Cardiol. 2004;59:369–381. 7.	 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. 8.	 Pletcher MJ, Bibbins-Domingo K, Lewis CE, et al. Prehypertension dur­ ing young adulthood and coronary calcium later in life. Ann Intern Med. 2008;149:91–99. 9.	 Juhola J, Magnussen CG, Berenson GS, et al. Combined effects of child and adult elevated blood pressure on subclinical atherosclerosis: the In­ ternational Childhood Cardiovascular Cohort Consortium. Circulation. 2013;128:217–224. 10.	 Cuspidi C, Sala C, Tadic M, et al. Pre-hypertension and subclinical carotid damage: a meta-analysis. J Hum Hypertens. 2019;33:34–40. 11.	 Lembo M, Pacella D, Manzi MV, et al. Hypertension-mediated organ dam­ age involving multiple sites is an independent risk factor for cardiovascular events. Eur Heart J Open. 2023;3:oead102. 12.	 Suvila K, Niiranen TJ. Interrelations between high blood pressure, organ damage, and cardiovascular disease: no more room for doubt. Hypertension. 2022;79:516–517. 13.	 SPRINT Research Group. A randomized trial of intensive versus standard

blood-pressure control. N Engl J Med. 2015;373:2103–2116.

5.3.1 Diabetes

1 Rahman F, McEvoy JW, Ohkuma T, et al. Effects of blood pressure low­

ering on clinical outcomes according to baseline blood pressure and car­ diovascular risk in patients with type 2 diabetes mellitus. Hypertension. 2019;73:1291–1299. 2.	 Emdin CA, Rahimi K, Neal B, et al. Blood pressure lowering in type 2 diabe­ tes: a systematic review and meta-analysis. JAMA. 2015;313:603–615. 3.	 Arguedas JA, Leiva V, Wright JM. Blood pressure targets for hyper­ tension in people with diabetes mellitus. Cochrane Database Syst Rev 2013;CD008277. 4.	 Yang Q, Zheng R, Wang S, et al. Systolic blood pressure control targets to prevent major cardiovascular events and death in patients with type 2 diabetes: a systematic review and network meta-analysis. Hypertension. 2023;80:1640–1653. 5.	 Bi Y, Li M, Liu Y, et al. Intensive blood-pressure control in patients with type 2 diabetes (BPROAD). N Engl J Med. 2025;392:1155–1167. 6.	 Hansson L, Zanchetti A, Carruthers SG, et al, HOT Study Group. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hy­ pertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. Lancet. 1998;351:1755–1762. 7.	 Whelton PK, Barzilay J, Cushman WC, et al. Clinical outcomes in antihyperten­ sive treatment of type 2 diabetes, impaired fasting glucose concentration, and normoglycemia: Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Arch Intern Med. 2005;165:1401–1409. 8.	 Keane WF, Brenner BM, de Zeeuw D, et al. The risk of developing endstage renal disease in patients with type 2 diabetes and nephropathy: the RENAAL study. Kidney Int. 2003;63:1499–1507. 9.	 Strippoli GF, Bonifati C, Craig M, et al. Angiotensin converting enzyme inhibi­ tors and angiotensin II receptor antagonists for preventing the progression of diabetic kidney disease. Cochrane Database Syst Rev 2006;2006:CD006257. 10.	 Palmer SC, Mavridis D, Navarese E, et al. Comparative efficacy and safety of blood pressure-lowering agents in adults with diabetes and kidney disease: a network meta-analysis. Lancet. 2015;385:2047–2056. 11.	 Schmieder RE, Hilgers KF, Schlaich MP, et al. Renin-angiotensin system and cardiovascular risk. Lancet. 2007;369:1208–1219. 12.	 Mann JF, Gerstein HC, Yi QL, et al. Progression of renal insufficiency in type 2 diabetes with and without microalbuminuria: results of the Heart Out­ comes and Prevention Evaluation (HOPE) randomized study. Am J Kidney Dis. 2003;42:936–942. 13.	 Kannel WB, Wilson PW, Zhang TJ. The epidemiology of impaired glucose tolerance and hypertension. Am Heart J. 1991;121:1268–1273. 14.	 Stamler J, Vaccaro O, Neaton JD, et al. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care. 1993;16:434–444. 15.	 SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373:2103–2116. 16.	 ACCORD Study Group. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010;362:1575–1585. 17.	 Wu W, Tong HM, Li YS, et al. The effect of semaglutide on blood pressure in

patients with type-2 diabetes: a systematic review and meta-analysis. Endo­ crine. 2024;83:571–584. 18 Solomon SD, Rice MM, K AJ, et al. Renal function and effectiveness of

angiotensin-converting enzyme inhibitor therapy in patients with chronic stable coronary disease in the Prevention of Events with ACE inhibition (PEACE) trial. Circulation. 2006;114:26–31.

5.3.2 Obesity and Metabolic Syndrome

1 Wilding JP, Batterham RL, Calanna S, et al. Once-weekly semaglutide

in adults with overweight or obesity. N Engl J Med. 2021;384:989– 1002. 2.	 Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med. 2023;389:2221–2232. 3.	 Rubino DM, Greenway FL, Khalid U, et al. Effect of weekly subcutaneous semaglutide vs daily liraglutide on body weight in adults with overweight or obesity without diabetes: the STEP 8 randomized clinical trial. JAMA. 2022;327:138–150. 4.	 Wadden TA, Bailey TS, Billings LK, et al. Effect of subcutaneous semaglu­ tide vs placebo as an adjunct to intensive behavioral therapy on body weight in adults with overweight or obesity: the STEP 3 randomized clinical trial. JAMA. 2021;325:1403–1413. 5.	 de Lemos JA, Linetzky B, le Roux CW, et al. Tirzepatide reduces 24-hour ambulatory blood pressure in adults with body mass index ≥27 kg/m2: SURMOUNT-1 ambulatory blood pressure monitoring substudy. Hyperten­ sion. 2024;81:e41-e43. 6.	 Schiavon CA, Cavalcanti AB, Oliveira JD, et al. Randomized trial of effect of bariatric surgery on blood pressure after 5 years. J Am Coll Cardiol. 2024;83:637–648. 7.	 Mottillo S, Filion KB, Genest J, et al. The metabolic syndrome and cardio­ vascular risk: a systematic review and meta-analysis. J Am Coll Cardiol. 2010;56:1113–1132. 8.	 Ndumele CE, Neeland IJ, Tuttle KR, et al. A synopsis of the evidence for the science and clinical management of cardiovascular-kidney-metabolic (CKM) syndrome: a scientific statement from the American Heart Associa­ tion. Circulation. 2023;148:1636–1664. 9.	 Ndumele CE, Rangaswami J, Chow SL, et al. Cardiovascular-kidneymetabolic health: a presidential advisory from the American Heart Associa­ tion. Circulation. 2023;148:1606–1635. 10.	 Martin SS, Aday AW, Almarzooq ZI, et al. 2024 Heart disease and stroke statistics: a report of US and global data from the American Heart Associa­ tion. Circulation. 2024;149:e347-e913. 11.	 Rubino D, Abrahamsson N, Davies M, et al. Effect of continued weekly sub­ cutaneous semaglutide vs placebo on weight loss maintenance in adults with overweight or obesity: the STEP 4 randomized clinical trial. JAMA. 2021;325:1414–1425. 12.	 King WC, Hinerman AS, Belle SH, et al. Comparison of the performance of common measures of weight regain after bariatric surgery for association with clinical outcomes. JAMA. 2018;320:1560–1569. 13.	 Kennedy C, Hayes P, Salama S, et al. The effect of semaglutide on blood pressure in patients without diabetes: a systematic review and metaanalysis. J Hypertens. 2023;41:e11. 14.	 Liu D, Huang Y, Huang C, et al. Calorie restriction with or without time-restricted eating in weight loss. N Engl J Med. 2022;386:1495– 1504. 15.	 Adams TD, Davidson LE, Litwin SE, et al. Weight and metabolic outcomes

12 years after gastric bypass. N Engl J Med. 2017;377:1143–1155.

5.3.3 Chronic Coronary Disease

1 Carrick D, Haig C, Maznyczka AM, et al. Hypertension, microvascular pa­

thology, and prognosis after an acute myocardial infarction. Hypertension. 2018;72:720–730. 2.	 Wright JT Jr, Williamson JD, Whelton PK, et al. Sprint Research Group. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373:2103–2116. 3.	 Bundy JD, Li C, Stuchlik P, et al. Systolic blood pressure reduction and risk of cardiovascular disease and mortality: a systematic review and network meta-analysis. JAMA Cardiol. 2017;2:775–781. 4.	 Lewis CE, Fine LJ, Beddhu S, et al. Sprint Research Group. Final report of a trial of intensive versus standard blood-pressure control. N Engl J Med. 2021;384:1921–1930. 5.	 Virani SS, Newby LK, Arnold SV, et al. 2023 AHA/ACC/ACCP/ASPC/

NLA/PCNA guideline for the management of patients with chronic coro­ nary disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2023;148:e9–e119.

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