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Paths Forward in Hypertension Awareness and Control, With Keith Ferdinand, MD
Ferdinand shares his advice on high blood pressure management, drawing on his perspective as co-author of the ACC/AHA 2025 hypertension guidelines.
Despite years of successful awareness campaigns and significant advancements in both treatment and prevention, high blood pressure (BP) – the most prevalent and modifiable risk factor for cardiovascular disease – is still insufficiently controlled in the US.1
The current American Heart Association (AHA)/American College of Cardiology (ACC) hypertension guidelines highlight a variety of prevention, diagnosis, and treatment strategies for patients at all points on the hypertension timeline. Given their continued relevance and the ongoing hypertension crisis in the US, the editorial team at HCPLive spoke with Keith Ferdinand, MD, the Gerald S. Berenson Chair in Preventive Cardiology, director of Preventive Cardiology at the Tulane University School of Medicine, and co-author of the AHA/ACC hypertension guidelines, to discuss the limitations still preventing patients from receiving optimal treatment.
“One of the main problems is that, early on in the process, you generally feel okay,” Ferdinand told HCPLive. “If you have severe hypertension, you may have chest pain, shortness of breath, headaches, dizziness, weakness, et cetera, but in most patients, especially when the blood pressure is only mildly or moderately elevated, they don’t have acute symptoms. That becomes a barrier, because many of us see treating disease as treating symptoms, and that’s not the case.”
A 2020 publication from the National Institutes of Health highlighted substantially reduced hypertension awareness among adults with the condition, particularly among younger patients. Its status as a “silent killer,” due in large part to its frequent asymptomatic presentation, makes it especially important for clinicians to spread awareness of both the disease’s effects and screening and treatment avenues available to patients with suspected high BP.2
The AHA/ACC guidelines corroborate this finding, with both awareness and control of hypertension cited as being far below target levels, due in large part to age- and race-based disparities. However, despite this issue being well-known and well-documented, the guidelines do not provide firm suggestions on improving awareness, instead listing it beneath the “evidence gaps” section. This indicates a need for further research and testing to establish the best course of action to improve public awareness.1
Ferdinand also highlights the guidelines’ perspective on the connection between obesity and hypertension, noting the correlation between increased adiposity and higher levels of BP. These conditions frequently co-occur, and when exhibited in tandem with other obesity-related metabolic conditions like dyslipidemia, the group of comorbidities is referred to as metabolic syndrome.1
The guidelines emphasize the importance of targeting the underlying pathophysiology of obesity as a component of hypertension management. However, the authors also note that some antihypertensive therapies, namely thiazide-type diuretics and beta-blockers, have been suggested to adversely impact metabolic health; however, outcome data from a variety of studies have not shown overt harm. Additionally, medications such as GLP-1 receptor agonists have shown substantial BP reductions in previous trials.1
“In the new guideline, we recognize that obesity is one of the risk factors for high blood pressure, and in fact, we suggest that weight loss is a pathway to better control of blood pressure,” Ferdinand said. “Some medicines, or even bariatric surgery if the patient has severe obesity, may be beneficial. Weight loss itself lowers blood pressure, improves cardiac function, overall lifestyle, and quality of life.”
Editors’ Note: Ferdinand reports disclosures with Amgen, Boehringer Ingelheim, Medtronic, Novartis, Eli Lilly, and Pfizer.
References
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. 2025;82(10). doi:10.1161/hyp.0000000000000249
Muntner P, Hardy S, Fine L, et al. Trends in Blood Pressure Control Among US Adults With Hypertension, 1999-2000 to 2017-2018. JAMA. 2020;324(12):1190-1200. doi:10.1001/jama.2020.14545
