The AMA and 10 other health care organizations have collaborated with the American Heart Association (AHA) and the American College of Cardiology (ACC) to update an influential guideline to prevent, detect, evaluate and manage high BP in adult patients. In some of the key updates, the new guideline—led by AHA/ACC and endorsed by the AMA and others—sets a minimum BP threshold for all patients to meet while confirming the association between lower BP and reduced dementia risk.
More than 115 million adults in the U.S. have hypertension, putting them at increased risk for heart attacks, strokes, heart failure, kidney disease and peripheral vascular disease.
The 2025 hypertension guidelines revise the 2017 version and emphasize the importance of multidisciplinary, team-based care to support the individual needs of patients and address structural barriers to controlling hypertension.
“We all take care of patients. This guideline was written by clinicians for you as clinicians and for your patients with a strong evidence base, but with practical application for clinicians,” said Daniel W. Jones, MD. He chaired the guideline-writing committee and is dean emeritus of the University of Mississippi School of Medicine.
Dr. Jones joined other guideline-writing committee members for a webinar sponsored by AMA and AHA as part of the Target: BP™ initiative to discuss the updated guidelines.
Experts covered the guidelines’ BP thresholds for diagnosis and treatment as well as the cardiovascular and cognitive risks of uncontrolled BP. They advised on how to calculate cardiovascular risk as part of clinical care and use appropriate medication classes and combination pill forms to improve control and adherence.
Brent M. Egan, MD, an AMA member who is the AMA’s vice president of cardiovascular disease prevention, served as a co-author and member of the guideline-writing committee. The AMA contributed significantly to the guideline’s underlying research, which builds on the MAP framework.
AMA MAP™ Hypertension is an evidence-based quality improvement program that provides a clear path to significant, sustained improvements in BP control. With the AMA MAP program, health care organizations can increase BP-control rates quickly. The program has demonstrated a 10% increase in BP control in six months with sustained results at one year.
Here are the five things doctors should know about the updated AHA/ACC hypertension guideline.
Four BP categories remain the same …
The new guideline retains 2017’s four BP categories for adults, as follows:
- Normal: Less than 120 mm Hg systolic and 80 mm Hg diastolic.
- Elevated: 120–129 mm Hg systolic and less than 80 mm Hg diastolic.
- Stage 1 hypertension: 130–139 mm Hg systolic or 80–89 mm Hg diastolic.
- Stage 2 hypertension: 140 mm Hg or more systolic or 90 mm Hg or more diastolic.
Patients whose BP is at or above 140/90 mm Hg or have stage 2 hypertension “get started with lifestyle therapy plus medications to begin with,” said Dr. Jones. For most of these patients, the guidelines recommend antihypertensive drug therapy with two first-line agents of different classes in a single pill, fixed-dose combination over two separate pills. That is to improve adherence and reduce time to achieve BP control.
If a stage one patient is at low risk, has no history of cardiovascular disease or chronic kidney disease or diabetes, and their PREVENT (Predicting Risk of CVD EVENTs) risk score is less than 7.5% for the 10-year risk, “you begin those patients with lifestyle therapy alone [and] continue the monitoring both in office blood pressure and home blood pressure at three to six months,” said Dr. Jones.
If the BP goal of 130/80 mm Hg is not met, that's the place to begin the medication in these patients, he added.
Additionally, any nonpregnant patient with severe hypertension (that is, more than 180/120 mm Hg) should get evaluated and treated with oral antihypertensive medications in a timely manner in the outpatient setting.
… but there’s a new BP goal
The overarching BP treatment goal revises 2017 guidelines, asking physicians and other health professionals to achieve a target of less than 130/80 mm Hg for all patients, with encouragement to achieve less than 120 mm Hg. This applies to both young and older patients, said Dr. Jones.
Research done in older patients has demonstrated the value of using the 140 mm Hg metric as a safe way to reduce cardiovascular and kidney disease, he said. Physicians and other health professionals should use their judgment based on the individual patient.
Lowering BP cuts dementia risk
Moving from “we think” to “we absolutely know” that lowering BP reduces the risk of dementia is another big change from the 2017 guidelines.
“Not only does lowering blood pressure prevent heart attacks and strokes but reduces the risk of dementia by 12% to 19%,” said Dr. Jones. In a revised recommendation, the updated guideline states that adults with hypertension should maintain a systolic BP of less than 130 mm Hg to prevent mild cognitive impairment and dementia.
Do this test for newly diagnosed patients
A patient with a newly confirmed diagnosis of hypertension should have a urine albumin to creatinine ratio test done.
“This test is the only new test that we recommend for the evaluation of the new patient with hypertension,” said Dr. Jones. It provides an earlier indication of chronic kidney disease than serum creatinine, and it’s widely available.
“It's not terribly expensive, and it's such a valuable tool in picking up chronic kidney disease at an early stage,” he advised.
Cut sodium intake and find substitutes
The guideline also emphasizes the importance of weight maintenance, moderate exercise and making dietary modifications to prevent or treat elevated BP and hypertension.
The authors of the guideline recommended potassium-based salt substitutes, “except in the presence of CKD [Chronic Kidney Disease] or use of drugs that reduce potassium excretion where additional monitoring is probably indicated.”
Americans on average consume about 3,400 milligrams of sodium a day. Cutting sodium intake is going to be very important in reducing hypertension, said AMA member Keith C. Ferdinand, MD, vice chair of the guideline-writing committee and professor of medicine at Tulane University School of Medicine.
The updated ACC/AHA hypertension guideline also continues to encourage home-BP monitoring combined with frequent interactions with multidisciplinary team members. Home-BP measurement is such a valuable tool, “and I do highly recommend that every one of your patients who has high blood pressure be taught to measure blood pressure at home with a good, validated device,” said Dr. Jones.
The AMA helped create the US Blood Pressure Validated Device Listing (VDL™), which identifies the BP measurement devices that have been independently validated for accuracy. The list—available at validatebp.org—now contains more than 120 validated home devices in a variety of price ranges. Validated cuff sizes are noted for each device.
Patients should avoid relying on cuffless devices such as smartwatches to accurately record BP until there is more evidence available on their reliability and precision.
Target: BP is an AMA/AHA national initiative that offers annual, recurring recognition for all participating sites that achieve hypertension control rates of 70% or higher among their adult patient population year over year. More resources are available at Target: BP to help physicians manage their patients’ hypertension, including a document on the top 10 takeaways of the 2025 guideline.
