Overview

• The AHA/ACC 2025 update keeps diagnostic categories but advises starting medication after 3–6 months of lifestyle changes if average readings stay at or above 130/80 mmHg, with a population goal of 130 mmHg or lower and an ideal target of 120 mmHg for some patients.
• Clinicians are directed to use the PREVENT risk calculator to individualize treatment intensity, reflecting newer evidence that tighter control also reduces cognitive decline risk.
• Lifestyle measures are strengthened with an ideal sodium goal of 1,500 mg per day, guidance to reduce or avoid alcohol, recommendations for weight loss and regular exercise, endorsement of the DASH diet, and encouragement of home blood pressure monitoring.
• The guidance expands evaluation for contributors and organ damage, including urine albumin‑to‑creatinine and aldosterone‑to‑renin ratio testing in higher‑risk or stage 2 hypertension, and it heightens monitoring and treatment attention during pregnancy and the postpartum period.
• A modeling study in Annals of Internal Medicine reports that targeting systolic pressure below 120 mmHg prevents more cardiovascular events and is cost‑effective, while increasing drug‑related adverse events and healthcare use, underscoring the need for shared decision‑making and careful implementation.