Breaking Down 2025 ACC/AHA Hypertension Guidelines, with Viet Le, PA-C, DMSc

On August 14, 2025, the American Heart Association (AHA) and the American College of Cardiology (ACC) published a revised set of clinical guidelines for the detection and management of hypertension, based on decisions from the ACC/AHA Joint Committee on Clinical Practice Guidelines. Titled the “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”, the new document replaces the 2017 guidelines.1

Aiming to collate all current knowledge in the field of high blood pressure to provide primary care and specialty clinicians with a comprehensive guide to managing hypertension, the document included detailed recommendations describing the processes of screening, treatment, and prevention of the condition.1

On August 26, 2025, HCPLive sat down with Viet Le, DMSc, PA-C, a preventive cardiology PA at Intermountain Health and the former president of the Academy of Physician Associates in Cardiology, to discuss the implications of these new guidelines and the impact they may have on the treatment landscape as hypertension becomes a greater burden for the public.

“The necessity of bringing 2025 forward in time was to reiterate that yes, stage 1 is 130-80, stage 2 is 140-90, and then we have elevated blood pressure regions,” Le told HCPLive. “But most importantly, we all agree that the goal is less than 130 systolic, the goal is less than 80 diastolic.”

The revised document includes a table detailing new recommendations, including improved and increased screening for primary aldosteronism, avoiding atenolol, ARB, ACEi, nitroprusside, MRA, or direct renin inhibitors in pregnant patients with hypertension, and suggestions to prevent cognitive impairment and dementia.1

Another significant change made in the new guidelines was a recommendation that health care professionals utilize the Predicting Risk of CVD EVENTs (PREVENT) risk calculator, which was derived from data including a more diverse sample of racial and ethnic groups. Additionally, PREVENT expands the investigatory scope to total CVD risk, including stroke, heart failure, and myocardial infarction.2

Le also went on to discuss the broader implications of these guidelines. He expressed concern as to the practical ability of the US healthcare system to manage the burden of hypertension proactively.

"I think health systems need to rise up to this because, hey, I’m one person, but I work within the confines of a healthcare system that either supports me being able to do public health practice or not,” Le said. “And so, if we’re just happy with fee-for-service and sick care, we’ll never get to proactive value-based care and actually deliver health care. I would say that the US healthcare system in particular is not ready for that burden because we’re incentivized the wrong way.”

Editor’s Note: Relevant disclosures for Le include Novartis, Pfizer, Amgen, and Janssen.

References

1. 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: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. Published online August 14, 2025. doi:10.1161/cir.0000000000001356

2. Jones, D, Ferdinand, K, Taler, S. 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: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. JACC. null2025, 0 (0). https://doi.org/10.1016/j.jacc.2025.05.007