Overview

• The new guidelines recommend starting medication if blood pressure remains at or above 130/80 mm Hg after three to six months of lifestyle changes and advise immediate treatment for patients with diabetes, chronic kidney disease or elevated cardiovascular risk.
• Clinicians are instructed to calculate 10-year risk using the AHA’s PREVENT tool with a 7.5% cutoff to guide earlier antihypertensive initiation, replacing pooled cohort equations.
• Ideal prevention now includes complete alcohol abstinence, with daily limits capped at one drink for women and two for men for those who choose to drink.
• Laboratory and screening updates call for universal urine albumin-to-creatinine testing, primary aldosteronism screening in resistant hypertension regardless of potassium levels, and class-1 pregnancy measures covering antihypertensives and low-dose aspirin education.
• The guidance cites a rural China trial linking intensive blood pressure control to roughly 15% lower dementia risk and highlights that changes will affect nearly half of U.S. adults with hypertension, prompting new discussions on clinical implementation and shared decision-making.