2025 ACC/AHA High Blood Pressure Guideline: Quick Reference
The bottom line of the 2025 AHA/ACC guideline for high blood pressure in adults: the same blood pressure categories as 2017, a new risk tool (PREVENT) for deciding who needs medication, a target below 130/80 for most adults, and broader testing for primary aldosteronism and kidney damage.
At a glance
- Categories are unchanged: normal under 120/80, elevated 120 to 129 systolic, stage 1 130 to 139 or 80 to 89, stage 2 140/90 or higher.
- Confirm the diagnosis with readings outside the office (home or ambulatory monitoring).
- Estimate 10-year cardiovascular risk with the PREVENT equations, which replace the pooled cohort equations.
- Stage 2, or stage 1 with cardiovascular disease, diabetes, chronic kidney disease or a PREVENT risk of 7.5% or more: start medication along with lifestyle changes.
- Aim for under 130/80 in most adults and encourage a systolic pressure under 120 when it is well tolerated.
- Start stage 2 with two first-line drugs, preferably in one pill; test urine albumin in everyone with hypertension; screen for primary aldosteronism in resistant hypertension.
Key recommendations
Diagnosis
Base the diagnosis on several properly measured office readings and confirm it with home or ambulatory monitoring, which also finds white-coat and masked hypertension.
Measure the urine albumin-to-creatinine ratio in every adult with hypertension, not only those with diabetes or kidney disease.
Risk and treatment
Use the PREVENT equations to estimate 10-year total cardiovascular risk in adults without known cardiovascular disease, and use the result to decide on drug treatment.
Start blood pressure medication, together with lifestyle changes, in adults with stage 2 hypertension.
Strength: COR 1Start medication for stage 1 hypertension when the patient has clinical cardiovascular disease, diabetes, chronic kidney disease or a PREVENT 10-year risk of 7.5% or more.
Strength: COR 1For stage 1 at lower risk, begin with lifestyle changes and add medication if blood pressure is still 130/80 or higher after 3 to 6 months.
Targets
Treat to under 130/80 in most adults, and encourage a systolic target under 120 when it can be reached without side effects.
Choosing drugs
Use first-line classes: thiazide-type diuretics, ACE inhibitors or ARBs, and long-acting dihydropyridine calcium channel blockers.
For stage 2, start with two first-line drugs from different classes, preferably as a single-pill combination, to improve control and adherence.
Strength: COR 1In adults with hypertension and overweight or obesity, a GLP-1 receptor agonist can be considered as part of weight and blood pressure management.
Lifestyle
Recommend sodium under 2,300 mg a day (ideally under 1,500 mg), potassium-enriched salt substitutes for patients without kidney disease or hyperkalemia risk, a DASH-style diet, regular physical activity and weight loss when needed.
Advise drinking no alcohol or as little as possible; for people who drink, no more than 2 drinks a day for men and 1 for women.
Secondary causes
Screen every adult with resistant hypertension for primary aldosteronism, whether or not potassium is low.
Strength: COR 1Evidence: LOE B-NRKeep most antihypertensives (except mineralocorticoid receptor antagonists) going when testing for primary aldosteronism, so screening is not delayed.
Strength: COR 1Evidence: LOE C-EO
Special populations
In pregnancy, treat chronic hypertension with medication when blood pressure is 140/90 or higher.
Lowering blood pressure also lowers the risk of mild cognitive impairment and dementia; this is a reason to treat to target in middle and older age.
Renal denervation may be considered for selected patients with resistant hypertension, at experienced centers.
Strength: COR 2b
How to read the grades ACC/AHA
Class of recommendation: 1 is strong (recommended), 2a is moderate (reasonable), 2b is weak (may be considered), 3 means no benefit or harm (do not do it). Level of evidence: A is high quality (several randomized trials or their meta-analyses), B-R is moderate from randomized trials, B-NR is moderate from nonrandomized studies, C-LD is limited data, C-EO is expert opinion.
What changed
Compared with the 2017 ACC/AHA high blood pressure guideline.
Risk tool
- Before
- Pooled cohort equations (10-year ASCVD risk of 10% for stage 1 treatment).
- Now
- PREVENT equations (10-year total cardiovascular risk, including heart failure), with a 7.5% threshold for stage 1 treatment.
Kidney testing
- Before
- Urine albumin testing was optional.
- Now
- Urine albumin-to-creatinine ratio for everyone with hypertension.
Primary aldosteronism
- Before
- Screening mainly in resistant hypertension or low potassium, often after stopping interfering drugs.
- Now
- Screening in all resistant hypertension regardless of potassium, without stopping most drugs first.
Targets
- Before
- Under 130/80 for most adults.
- Now
- Under 130/80, with a systolic pressure under 120 encouraged when tolerated.
Pregnancy
- Before
- Treatment thresholds for chronic hypertension in pregnancy were less defined.
- Now
- Treat at 140/90 or higher.
New topics
- Before
- Not covered.
- Now
- Cognitive health, GLP-1 receptor agonists for patients with obesity, and renal denervation for resistant hypertension.
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Questions clinicians ask
Did the blood pressure categories change in 2025?
No. Normal, elevated, stage 1 and stage 2 have the same cutoffs as in 2017. What changed is how risk is estimated and who is offered medication.
Why does the guideline use PREVENT instead of the pooled cohort equations?
PREVENT was built on more recent and more diverse cohorts, does not use race, includes kidney and metabolic measures, and estimates total cardiovascular risk including heart failure. It tends to give lower risk estimates than the pooled cohort equations, so the treatment threshold was set at 7.5%.
What should I do for a patient with stage 1 hypertension and low risk?
Start with lifestyle changes and recheck. If blood pressure is still 130/80 or higher after 3 to 6 months, the guideline supports adding medication.
Is the target now a systolic pressure under 120?
The target for most adults is under 130/80. The guideline encourages going lower, toward a systolic pressure under 120, when patients tolerate it.
Sources
- Jones DW, Ferdinand KC, Taler SJ, et al. 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. J Am Coll Cardiol. Published online August 14, 2025. doi.org/10.1016/j.jacc.2025.05.007
- Khan SS, Matsushita K, Sang Y, et al. Development and validation of the American Heart Association's PREVENT equations. Circulation. 2024;149:430-449. doi.org/10.1161/CIRCULATIONAHA.123.067626
- Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Hypertension. 2018;71:e13-e115. doi.org/10.1161/HYP.0000000000000065
Summarized in our own words by 2 Minute Medicine's physician editors from the source documents listed here. Strength and evidence grades are the guideline authors' own. This is a quick reference, not a substitute for the full guideline or for clinical judgment.
For health care professionals. 2 Minute Medicine is independent and is not affiliated with or endorsed by the societies that write these guidelines.
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