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CLINICAL STATEMENTS AND GUIDELINES

September 16, 2025 Circulation. 2025;152:e114–e218. DOI: 10.1161/CIR.0000000000001356 e204

results of a prospective randomized controlled study (MOSES). Stroke. 2005;36:1218–1226. 17.	 Jeffers BW, Robbins J, Bhambri R. Efficacy of calcium channel blockers versus other classes of antihypertensive medication in the treatment of hy­ pertensive patients with previous stroke and/or coronary artery disease: a systematic review and meta-analysis. Am J Ther. 2017;24:e68-e80. 18.	 Benavente OR, Coffey CS, Conwit R, et al. S. P. S. Study Group. Bloodpressure targets in patients with recent lacunar stroke: the SPS3 ran­ domised trial. Lancet. 2013;382:507–515. 19.	 Yusuf S, Diener HC, Sacco RL, et al. Telmisartan to prevent recurrent stroke

and cardiovascular events. N Engl J Med. 2008;359:1225–1237.

5.3.9.4 Mild Cognitive Impairment and Dementia

1 Peters R, Collerton J, Granic A, et al. Antihypertensive drug use and risk

of cognitive decline in the very old: an observational study - the Newcastle 85+ Study. J Hypertens. 2015;33:2156–2164. 2.	 Hughes D, Judge C, Murphy R, et al. Association of blood pressure lowering with incident dementia or cognitive impairment: a systematic review and meta-analysis. JAMA. 2020;323:1934–1944. 3.	 Williamson JD, Pajewski NM, Auchus AP, et al. Effect of intensive vs stan­ dard blood pressure control on probable dementia: a randomized clinical trial. JAMA. 2019;321:553–561. 4.	 Reboussin DM, Gaussoin SA, Pajewski NM, et al. Long-term effect of inten­ sive vs standard blood pressure control on mild cognitive impairment and probable dementia in SPRINT. Neurology. 2025;104:e213334. 5.	 He J. Effectiveness of blood pressure reduction on all-cause demen­ tia among patients with hypertension: an open-label, blinded-endpoint, cluster-randomized trial. Nat Med. Published online April 21, 2025. doi: 10.1038/s41591-025-03616-8. 6.	 Alzheimer's Association. 2023 Alzheimer's disease facts and figures. Al­ zheimers Dement. 2023;19:1598–1695. 7.	 Petersen RC, Lopez O, Armstrong MJ, et al. Practice guideline update sum­ mary: mild cognitive impairment: report of the Guideline Development, Dis­ semination, and Implementation Subcommittee of the American Academy of Neurology. Neurology. 2018;90:126–135. 8.	 Brookmeyer R, Corrada MM, Curriero FC, et al. Survival following a diagno­ sis of Alzheimer disease. Arch Neurol. 2002;59:1764–1767. 9.	 Malone JE, Elkasaby MI, Lerner AJ. Effects of hypertension on Alzheimer's disease and related disorders. Curr Hypertens Rep. 2022;24:615–625. 10.	 Palta P, Albert MS, Gottesman RF. Heart health meets cognitive health: evi­ dence on the role of blood pressure. Lancet Neurol. 2021;20:854–867. 11.	 Williamson JD, Supiano MA, Applegate WB, et al. Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged >/=75 years: a randomized clinical trial. JAMA. 2016;315:2673–2682. 12.	 Sweeney MD, Montagne A, Sagare AP, et al. Vascular dysfunction-the disre­ garded partner of Alzheimer's disease. Alzheimers Dement. 2019;15:158– 167. 13.	 Iadecola C, Duering M, Hachinski V, et al. Vascular cognitive impairment and dementia: JACC Scientific Expert Panel. J Am Coll Cardiol. 2019;73:3326– 3344. 14.	 Longstreth WT Jr, Manolio TA, Arnold A, et al. Clinical correlates of white matter findings on cranial magnetic resonance imaging of 3301 elderly people. The Cardiovascular Health Study. Stroke. 1996;27:1274–1282. 15.	 Gronewold J, Jokisch M, Schramm S, et al. Association of regional white matter hyperintensities with hypertension and cognition in the populationbased 1000BRAINS study. Eur J Neurol. 2023;30:1174–1190. 16.	 Zhao Y, Ke Z, He W, et al. Volume of white matter hyperintensities in­ creases with blood pressure in patients with hypertension. J Int Med Res. 2019;47:3681–3689. 17.	 de Havenon A, Sheth KN, Yeatts SD, et al. White matter hyperintensity pro­ gression is associated with incident probable dementia or mild cognitive impairment. Stroke Vasc Neurol. 2022;7:364–366. 18.	 Qiu C, Winblad B, Fratiglioni L. The age-dependent relation of blood pres­ sure to cognitive function and dementia. Lancet Neurol. 2005;4:487– 499. 19.	 Kivipelto M, Helkala EL, Hanninen T, et al. Midlife vascular risk factors and late-life mild cognitive impairment: a population-based study. Neurology. 2001;56:1683–1689. 20.	 Lennon MJ, Lam BCP, Lipnicki DM, et al. Use of antihypertensives, blood pressure, and estimated risk of dementia in late life: an individual participant data meta-analysis. JAMA Netw Open. 2023;6:e2333353. 21.	 Peters R, Xu Y, Fitzgerald O, et al. Blood pressure lowering and preven­

tion of dementia: an individual patient data meta-analysis. Eur Heart J. 2022;43:4980–4990. 22 Staessen JA, Fagard R, Thijs L, et al. Randomised double-blind comparison

of placebo and active treatment for older patients with isolated systolic hy­ pertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investiga­ tors. Lancet. 1997;350:757–764. 23.	 Czernichow S, Ninomiya T, Huxley R, et al. Impact of blood pressure lower­ ing on cardiovascular outcomes in normal weight, overweight, and obese individuals: the Perindopril Protection Against Recurrent Stroke Study trial. Hypertension. 2010;55:1193–1198. 24.	 Williamson JD, Pajewski NM, Auchus AP, et al. Sprint Mind investigators

for the SPRINT Research Group. Effect of intensive vs standard blood pressure control on probable dementia: a randomized clinical trial. JAMA. 2019;321:553–561.

5.3.10 Peripheral Artery Disease

1 Lawes CM, Vander Hoorn S, Rodgers A, et al. Global burden of blood-

pressure-related disease, 2001. Lancet. 2008;371:1513–1518. 2.	 Kennedy M, Solomon C, Manolio TA, et al. Risk factors for declining anklebrachial index in men and women 65 years or older: the Cardiovascular Health Study. Arch Intern Med. 2005;165:1896–1902. 3.	 Piller LB, Simpson LM, Baraniuk S, et al. Characteristics and long-term follow-up of participants with peripheral arterial disease during ALLHAT. J Gen Intern Med. 2014;29:1475–1483. 4.	 Diehm C, Pittrow D, Lawall H. Effect of nebivolol vs. hydrochlorothiazide on the walking capacity in hypertensive patients with intermittent claudication. J Hypertens. 2011;29:1448–1456. 5.	 Paravastu SC, Mendonca DA, Da Silva A. Beta blockers for peripheral arte­ rial disease. Cochrane Database Syst Rev 2013;2013:CD005508. 6.	 Espinola-Klein C, Weisser G, Jagodzinski A, et al. Beta-blockers in pa­ tients with intermittent claudication and arterial hypertension: results from the nebivolol or metoprolol in arterial occlusive disease trial. Hypertension. 2011;58:148–154. 7.	 Sleight P. The HOPE study (Heart Outcomes Prevention Evaluation). J Re­ nin Angiotensin Aldosterone Syst 2000;1:18–20. 8.	 Investigators O, Yusuf S, Teo KK, et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med. 2008;358:1547– 1559. 9.	 Gornik HL, Aronow HD, Goodney PP, et al. 2024 ACC/AHA/AACVPR/

APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the manage­ ment of lower extremity peripheral artery disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024:149;e1313–e1410.

5.4 Plan of Care for Hypertension

1 Ogungbe O, Cazabon D, Ajenikoko A, et al. Determining the frequency and

level of task-sharing for hypertension management in LMICs: a systematic review and meta-analysis. EClinicalMedicine. 2022;47:101388. 2.	 He J, Irazola V, Mills KT, et al. Effect of a community health worker-led mul­ ticomponent intervention on blood pressure control in low-income patients in Argentina: a randomized clinical trial. JAMA. 2017;318:1016–1025. 3.	 Santschi V, Chiolero A, Colosimo AL, et al. Improving blood pressure control through pharmacist interventions: a meta-analysis of randomized controlled trials. J Am Heart Assoc. 2014;3:e000718. 4.	 Victor RG, Lynch K, Li N, et al. A cluster-randomized trial of blood-pressure reduction in black barbershops. N Engl J Med. 2018;378:1291–1301. 5.	 Abdalla M, Bolen SD, Brettler J, et al. Implementation strategies to improve blood pressure control in the United States: a scientific statement from the American Heart Association and American Medical Association. Hyperten­ sion. 2023;80:e143-e157. 6.	 Fontil V, Gupta R, Moise N, et al. Adapting and evaluating a health system intervention from Kaiser Permanente to improve hypertension management and control in a large network of safety-net clinics. Circ Cardiovasc Qual Outcomes. 2018;11:e004386. 7.	 Jaffe MG, Lee GA, Young JD, et al. Improved blood pressure control asso­ ciated with a large-scale hypertension program. JAMA. 2013;310:699– 705. 8.	 Hanlin RB, Asif IM, Wozniak G, et al. Measure accurately, Act rapidly, and Partner with patients (MAP) improves hypertension control in medically un­ derserved patients: Care Coordination Institute and American Medical As­ sociation Hypertension control project pilot study results. J Clin Hypertens (Greenwich) 2018;20:79–87. 9.	 Behling EM, Garris T, Blankenship V, et al. Improvement in hypertension

control among adults seen in federally qualified health center clinics in the Stroke Belt: implementing a program with a dashboard and process metrics. Health Equity. 2023;7:89–99.

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