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The American Heart Association has updated high blood pressure guidelines

In August 2025, the American Heart Association/American College of Cardiology (AHA/ACC) published updated high blood pressure (also known as hypertension) guidelines. The guidelines, updated for the first time since 2017, include several new recommendations that patients and their primary care providers should know.

“These are the most up-to-date guidelines for treating patients with one of the most modifiable cardiovascular risk factors, hypertension,” said Garima Sharma MD, FACC, FAHA, Martha Schar Chair of Women’s Cardiovascular Health, and Director of Preventive Cardiology and Women’s Cardiovascular Health, Inova Schar Heart and Vascular.

1. Aim to keep blood pressure under 130/80 mmHg

The recommended universal treatment target is a blood pressure of less than 130/80 mmHg, with a goal of getting as close to 120/80 mmHg as possible.

For stage 1 high blood pressure (blood pressure that is consistently between 130/80 and139/89 mm Hg), the guidelines first recommend lifestyle modifications for three to six months. But if those changes don’t bring the blood pressure down to 130/80 mmHg or lower, the guidelines strongly recommend starting medication.

2. Providers: use the PREVENT tool to help determine a patient’s risk

The AHA introduced updates to the PREVENT screening assessment tool, which physicians or nurse practitioners can use as part of annual physicals. The updates include data that helps to predict the risk of both heart disease and heart failure. The PREVENT tool now has a lower threshold for the “high risk” category. The 2025 ACC/AHA guideline recommends starting medication to lower blood pressure if patients meet any of the following criteria:

Stage 1 hypertension (blood pressure that is consistently between 130/80 and139/89 mm Hg) and existing cardiovascular disease
Chronic kidney disease
Diabetes
A PREVENT 10-year total cardiovascular risk score of 7.5% or more

“As a result of the updated PREVENT calculator, we estimate that a lot more people will be eligible for hypertension management just based on the cutoffs for preventive treatment and the blood pressure target,” Dr. Sharma said.

3. More high blood pressure recommendations

For all adults with stage 2 hypertension (blood pressure of 140/90 mm Hg or higher), the guidelines make a new recommendation. Providers should start patients on two blood pressure lowering medications at once – preferably in a single pill rather than two different pills. The detailed guidelines also included specific recommendations by types of high blood pressure including secondary hypertension, resistant hypertension and pregnancy-associated hypertension.

4. Renal denervation highlighted to treat resistant hypertension

Blood pressure that cannot be controlled using medications is known as resistant hypertension. It is defined as high blood pressure that is greater than 140/90 mm Hg, even though a patient is taking three medications, or blood pressure that requires four or more medications to control. In those instances, the updated guidelines include a minimally invasive catheter-based technology called renal denervation among the recommendations.

Renal denervation received FDA approval in November 2023. It works by stopping some nerves in the kidneys from telling the body to store so much fluid and sodium. With less extra salt and water in the body, blood pressure goes down.

“What we have observed from real-world data nationally and here at Inova is that up to 90 days after the renal denervation procedure, patients are actually seeing even higher levels of blood pressure reduction than we anticipated,” said Behnam Tehrani, MD, System Associate Director for Interventional Cardiology, Executive Director of Cardiac Catheterization Laboratories for Inova Schar Heart and Vascular, and Co-Director of Inova’s Complex Coronary Therapeutic Program. “Here at Inova, we are seeing reductions in systolic blood pressure reductions of at least 20 points and diastolic blood pressures of at least eight points. These findings are impressive, considering that simply a five-point reduction in systolic blood pressure in these patients is associated with 15% reduction in cardiovascular complications.”

The Centers for Medicare & Medicaid Services recently expanded its coverage of renal denervation procedures for Medicare patients. As with many procedures, prior authorization may be needed to ensure patients meet the medical criteria for renal denervation.

5. A focus on lifestyle management

These updated guidelines emphasized lifestyle management tactics as a key element of patient care:

Weight loss is a strong recommendation
A low-sodium diet (less than 2,300 mg) is another strong recommendation – the guidelines specifically highlighted the DASH diet
Potassium substitutes or salt substitutes were recommended
Mindfulness and meditation also earned a recommendation

“Recommendations that recognize the importance of mindfulness, calming techniques, medication and meditation in reducing hypertension was really nice to see,” Dr. Sharma noted.

6. Team-based patient care is key

Multidisciplinary team-based care that incorporates a community-based approach is crucial. It can help address issues that can stand in the way of patients getting the care they need by addressing patient access to medications and supporting individual patients’ needs. The team may include physicians, pharmacists, nurse practitioners, nurses, physician assistants, dietitians, community health workers and other healthcare professionals.

“While achieving this approach may be a challenge for individual practices, Inova offers a preventive cardiology program that personalizes treatment plans and incorporates elements of multidisciplinary care to manage hypertension,” Dr. Sharma said.

Why these updated guidelines are so important

“Hypertension is the single largest modifiable risk factor for heart disease, and it continues to increase, including among younger populations,” Dr. Sharma said. “That’s why Inova offers specialized care for hypertension.”

Inova’s comprehensive services include:

A preventive cardiology program
A robust weight-loss program that includes medical and surgical options
Renal denervation expertise through our resistant hypertension program
A specialized women’s cardiovascular health program that treats high blood pressure including before, during and after pregnancy