Overview

• The guideline lowers the threshold for pharmacologic treatment to sustained readings of at least 130/80 mm Hg after 3–6 months of lifestyle intervention and advises immediate medication for adults with diabetes, chronic kidney disease or elevated cardiovascular risk.
• Clinicians are urged to use the PREVENT 10-year risk calculator with a 7.5% treatment cutoff in place of pooled-cohort equations to guide antihypertensive drug decisions.
• Lifestyle recommendations emphasize ideal alcohol abstinence, a daily sodium cap of 1,500 mg and continued promotion of the DASH diet, increased potassium intake and weight management.
• New mandates require urine albumin-to-creatinine ratio testing for all patients with hypertension and class-1 screening for primary aldosteronism in resistant cases regardless of potassium levels.
• The guideline adds a focus on intensive blood pressure control to reduce dementia risk and strengthens pregnancy care with class-1 recommendations for chronic hypertension therapy and low-dose aspirin to prevent preeclampsia.