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CLINICAL STATEMENTS AND GUIDELINES

Circulation. 2025;152:e114–e218. DOI: 10.1161/CIR.0000000000001356 September 16, 2025 e201

6 Bohm M, Schumacher H, Teo KK, et al. Achieved diastolic blood pressure

and pulse pressure at target systolic blood pressure (120-140 mm Hg) and cardiovascular outcomes in high-risk patients: results from ONTARGET and TRANSCEND trials. Eur Heart J. 2018;39:3105–3114. 7.	 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. 8.	 Yndigegn T, Lindahl B, Mars K, et al. Beta-blockers after myocardial in­ farction and preserved ejection fraction (REDUCE-AMI). N Engl J Med. 2024;390:1372–1381. 9.	 Jeffers BW, Robbins J, Bhambri R. Efficacy of calcium channel blockers versus other classes of antihypertensive medication in the treatment of hypertensive patients with previous stroke and/or coronary artery dis­ ease: a systematic review and meta-analysis. Am J Ther. 2017;24:e68e80. 10.	 Lubsen J, Wagener G, Kirwan BA, et al. Effect of long-acting nifedipine on

mortality and cardiovascular morbidity in patients with symptomatic stable angina and hypertension: the ACTION trial. J Hypertens. 2005;23:641– 648.

5.3.4 Prevention of HF in Adults With Hypertension

1 Lv J, Ehteshami P, Sarnak MJ, et al. Effects of intensive blood pressure

lowering on the progression of chronic kidney disease: a systematic review and meta-analysis. CMAJ. 2013;185:949–957. 2.	 Reboldi G, Angeli F, Gentile G, et al. Benefits of more intensive versus less intensive blood pressure control. Updated trial sequential analysis. Eur J Intern Med. 2022;101:49–55. 3.	 Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering on outcome incidence in hypertension: 7. Effects of more vs. less inten­ sive blood pressure lowering and different achieved blood pressure levels - updated overview and meta-analyses of randomized trials. J Hypertens. 2016;34:613–622. 4.	 Xie X, Atkins E, Lv J, et al. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and metaanalysis. Lancet. 2016;387:435–443. 5.	 Siddiqi TJ, Usman MS, Siddiqui A, et al. Association of low diastolic blood pressure with cardiovascular outcomes and all-cause mortality: a metaanalysis. Curr Probl Cardiol. 2024;49:102131. 6.	 Baffour PK, Jahangiry L, Jain S, et al. Blood pressure, hypertension, and the risk of heart failure: a systematic review and meta-analysis of cohort studies. Eur J Prev Cardiol. 2024;31:529–556. 7.	 Bibbins-Domingo K, Pletcher MJ, Lin F, et al. Racial differences in inci­ dent heart failure among young adults. N Engl J Med. 2009;360:1179– 1190. 8.	 Effects of treatment on morbidity in hypertension. II. Results in patients with diastolic blood pressure averaging 90 through 114 mm Hg. JAMA. 1970;213:1143–1152. 9.	 Kostis JB, Davis BR, Cutler J, et al, SHEP Cooperative Research Group. Prevention of heart failure by antihypertensive drug treatment in older per­ sons with isolated systolic hypertension. JAMA. 1997;278:212–216. 10.	 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. 11.	 Thomopoulos C, Bazoukis G, Tsioufis C, et al. Beta-blockers in hyperten­ sion: overview and meta-analysis of randomized outcome trials. J Hypertens. 2020;38:1669–1681. 12.	 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.

5.3.4.1 HF With Reduced Ejection

1 Khan SU, Khan MZ, Alkhouli M. Trends of clinical outcomes and health

care resource use in heart failure in the United States. J Am Heart Assoc. 2020;9:e016782. 2.	 Drazner MH. The progression of hypertensive heart disease. Circulation. 2011;123:327–334. 3.	 Multicenter Diltiazem Postinfarction Trial Research Group. The effect of dil­ tiazem on mortality and reinfarction after myocardial infarction. N Engl J Med. 1988;319:385–392. 4.	 Goldstein RE, Boccuzzi SJ, Cruess D, et al, The Adverse Experience

Committee; and the Multicenter Diltiazem Postinfarction Research Group. Diltiazem increases late-onset congestive heart failure in postin­ farction patients with early reduction in ejection fraction. Circulation. 1991;83:52–60. 5.	 Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guide­

line for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Prac­ tice Guidelines. Circulation. 2022;145:e895–e1032.

5.3.4.2 HF With Preserved Ejection Fraction

1 Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guide­

line for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Prac­ tice Guidelines. Circulation. 2022;145:e895–e1032. 2.	 Kittleson MM, Panjrath GS, Amancherla K, et al. 2023 ACC ex­ pert consensus decision pathway on management of heart failure with preserved ejection fraction: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2023;81:1835–1878. 3.	 Solomon SD, McMurray JJV, Anand IS, et al. Angiotensin-neprilysin in­ hibition in heart failure with preserved ejection fraction. N Engl J Med. 2019;381:1609–1620. 4.	 Anker SD, Butler J, Filippatos G, et al. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med. 2021;385:1451–1461. 5.	 Kario K, Ferdinand KC, O'Keefe JH. Control of 24-hour blood pressure with SGLT2 inhibitors to prevent cardiovascular disease. Prog Cardiovasc Dis. 2020;63:249–262. 6.	 Zhang Q, Zhou S, Liu L. Efficacy and safety evaluation of SGLT2i on blood

pressure control in patients with type 2 diabetes and hypertension: a new meta-analysis. Diabetol Metab Syndr. 2023;15:118.

5.3.5 Atrial Fibrillation

1 Joglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/

HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology/American Heart As­ sociation Joint Committee on Clinical Practice Guidelines. Circulation. 2024;149:e1–e156. 2.	 Huxley RR, Lopez FL, Folsom AR, et al. Absolute and attributable risks of atrial fibrillation in relation to optimal and borderline risk factors: the Athero­ sclerosis Risk in Communities (ARIC) study. Circulation. 2011;123:1501– 1508. 3.	 Verdecchia P, Angeli F, Reboldi G. Hypertension and atrial fibrillation: doubts and certainties from basic and clinical studies. Circ Res. 2018;122:352– 368. 4.	 Kornej J, Borschel CS, Benjamin EJ, et al. Epidemiology of atrial fibrillation in the 21st century: novel methods and new insights. Circ Res. 2020;127:4– 20. 5.	 Soliman EZ, Rahman AF, Zhang ZM, et al. Effect of intensive blood pressure lowering on the risk of atrial fibrillation. Hypertension. 2020;75:1491–1496. 6.	 Emdin CA, Callender T, Cao J, et al. Effect of antihypertensive agents on risk of atrial fibrillation: a meta-analysis of large-scale randomized trials. Euro­ pace. 2015;17:701–710. 7.	 Pinho-Gomes AC, Azevedo L, Copland E, et al. Blood pressure-lowering treatment for the prevention of cardiovascular events in patients with atrial fibrillation: an individual participant data meta-analysis. PLoS Med. 2021;18:e1003599. 8.	 Gawalko M, Linz D. Atrial fibrillation detection and management in hyperten­ sion. Hypertension. 2023;80:523–533. 9.	 Neefs J, van den Berg NW, Limpens J, et al. Aldosterone pathway blockade

to prevent atrial fibrillation: a systematic review and meta-analysis. Int J Car­ diol. 2017;231:155–161.

5.3.6 Valvular Heart Disease

1 Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the

management of patients with valvular heart disease: a report of the Ameri­ can College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;143:e72–e227. 2.	 Antonini-Canterin F, Huang G, Cervesato E, et al. Symptomatic aortic ste­ nosis: does systemic hypertension play an additional role? Hypertension. 2003;41:1268–1272. 3.	 Rieck AE, Cramariuc D, Staal EM, et al. Impact of hypertension on left

ventricular structure in patients with asymptomatic aortic valve stenosis (a SEAS substudy). J Hypertens. 2010;28:377–383.

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