2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM guideline for the prevention, detection, evaluation and management of high blood pressure in adults: a commentary from the European Renal Best Practice (ERBP)

Abstract

American Scientific Societies (AHA/ACC and others) updated in 2025 the guideline on High Blood Pressure following 2024 ESC and 2023 ESH updates from Europe. Guidelines mostly agree on who should receive pharmacotherapy and on a common target of systolic blood pressure (SBP; <130 mmHg) and diastolic blood pressure (DBP) <80 mmHg for most, as well as on individualizing BP targets according to patient characteristics. However, they differ in nomenclature, pharmacotherapy for people at lower cardiovascular risk and aiming at SBP <120 mmHg. Overall, 2025 AHA/ACC supports pharmacotherapy earlier and achieving lower BP targets than other recent guidelines: it recommends [high cardiovascular disease (CVD) risk] or finds reasonable (not high CVD risk, if not corrected by lifestyle) initiating pharmacotherapy for hypertension, defined as SBP >= 130 mmHg or DBP >= 80 mmHg. The recommended (high CVD risk) or reasonable (not high CVD risk) target is SBP at least <130 mmHg, with encouragement to achieve SBP <120 mmHg, and DBP <80 mmHg. However, 2024 ESC and 2023 ESH use alternative terms (high normal or elevated blood pressure) for blood pressure values (i.e. >= 130-139 or >= 80-89 mmHg) that require pharmacotherapy only in high-risk groups. Additionally, 2023 ESH recommends avoiding actively aiming for SBP <120 mmHg or DBP <70 mmHg. 2024 KDIGO avoids the term hypertension and suggests a target SBP <120 mmHg for people with chronic kidney disease. It would be desirable that guidelines converge on such key issues as nomenclature and therapeutic targets.