Leveraging New Therapies and Guidelines in Hypertension, With Vivek Bhalla, MD

On August 14, the American Heart Association (AHA) and American College of Cardiology (ACC) released a revised and updated set of clinical guidelines for the detection, diagnosis, 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 provide clinicians with a comprehensive document for managing hypertension, the authors collated all recent research and developments from December 2023 to June 2024, identifying key studies, reviews, and other evidence. These were ultimately combined to form the 2025 guidelines.2

Notably, the authors also collected data on newer treatment methods, such as aprocitentan (Tryvio) and GLP-1 receptor agonists.1

“I think we should, as a hypertension community, celebrate the fact that there are new therapies for a morbid condition in which we have poor control rates, but I think there’s some ambiguity,” said Vivek Bhalla, MD, associate professor of medicine at Stanford Medicine, in an interview with HCPLive. “I think ambiguity is actually a good thing in this case, because we just don’t have the data yet to be too prescriptive about when these medicines slot in after known medicines.”

Bhalla went on to discuss the inclusion of the recently approved aprocitentan. Shown in clinical trials to reduce 24-hour ambulatory systolic blood pressure by 4 to 6 mm Hg versus placebo, the dual endothelin A and B receptor agonist became the first and only agent in its class approved by the US Food and Drug Administration (FDA) for the treatment of uncontrolled hypertension in adult patients in March of 2024.3

“Aprocitentan had been studied in a resistant hypertensive population but curiously was approved by the FDA for a broader indication than that,” Bhalla added. “The lower dose of aprocitentan was approved by the FDA for uncontrolled hypertension, which is a broader term than resistant hypertension. That was a bit of a surprise to many of us in the community, but it’s allowing for more liberal usage of the medication.”

Bhalla also discussed the potential applications of GLP-1 RAs in the hypertension sphere. The guidelines noted this weight reduction medication as an effective way of lowering blood pressure, due to the correlation between obesity and hypertension. Additionally, their potential secondary functions, such as slowing kidney decline with or without the presence of diabetes, could help reduce urinary albumin.1

“I think it’s very important to say that they are a medication that has been proven in certain contexts for heart disease and then in context for kidney disease in the diabetic population. They do help lower blood pressure,” Bhalla said. “But it should not be prescribed as an end-line medication in blood pressure because it simply hasn’t been tried and tested in that way.”

Before concluding, Bhalla expressed his excitement about the future of the hypertension treatment landscape, highlighting aldosterone inhibitors and co-directed medical therapy as points of interest moving forward.

Editor's Note: Bhalla reports disclosures with AstraZeneca, Bayer Pharmaceuticals, Idorsia Pharmaceuticals, Medtronic, Nephrogen, Janssen Pharmaceuticals, and others.

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. Hypertension. Published online August 14, 2025. doi:10.1161/HYP.0000000000000249

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

3. Brett, A. Aprocitentan, a Newly Approved Drug for Resistant Hypertension. NEJM Journal Watch. April 11, 2024. Accessed September 3, 2025. https://www.jwatch.org/na57341/2024/04/11/aprocitentan-newly-approved-drug-resistant-hypertension