Updating the Hypertension Treatment Landscape With Manesh Patel, MD

On August 14, 2025, the American Heart Association (AHA) and American College of Cardiology (ACC) released a revised set of clinical guidelines for the management of hypertension among adults. Based on decisions from the ACC/AHA Joint Committee on Clinical Practice Guidelines, 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” replaces the existing 2017 guidelines.1

Investigators undertook a comprehensive examination of all recent research and developments in hypertension from December 2023 to June 2024, picking out key studies, reviews, and other evidence. These were collated and combined into the 2025 guidelines, which aim to provide clinicians with a “living” document for the treatment of hypertension.2

“I think the guidelines highlight important features for people with difficult-to-manage or difficult-to-control blood pressure,” Manesh Patel, MD, chief of the divisions of cardiology and clinical pharmacology at the Duke University School of Medicine, said in an interview with HCPLive. “The first is that somewhere around 47% – almost half – of Americans have high blood pressure. So when you have such a large number of people with high blood pressure, you obviously have a significant number of people who require more than one medication who might still be hypertensive.”

Patel noted several important takeaways from the updated guidelines, including an increased emphasis on lifestyle changes, the creation of the PREVENT calculator, and more aggressive treatment for stage 2 hypertension after the lowering of the threshold for stage 1 hypertension.

“For patients with stage 2 hypertension, greater than 140/90, they now prefer the use of at least two first-line antihypertensive medications of different classes, sometimes in a single pill or a fixed dose,” Patel told HCPLive. “The guidelines also emphasize lifestyle changes; reducing sodium intake, limiting alcohol consumption, eating a heart-healthy diet, maintaining a healthy weight, physical activity, and managing stress.”

Patel also discussed the increasing focus on GLP-1 receptor agonists, noting the need for further research before incorporating them into the treatment cascade.

“Obviously, we await more studies with GLP-1 receptor agonists, as they will probably play a role in two places that the guidelines mentioned,” Patel said. “One is weight loss, and the second is, of course, an important potential therapeutic effect on cardiovascular events and also kidney events.”

Looking forward, Patel expressed his excitement for several upcoming treatments and trials in the hypertension sphere, pointing out aprocitentan and aldosterone antagonists, such as spironolactone.

“Because it’s such a large problem, we need more arrows in our quiver,” Patel said. “So, more therapeutics are really great. I’m excited about longer-acting therapeutics, because they’ll likely give us a better chance for adherence and potentially a larger outcome of benefit for our patients.”

Ultimately, Patel left patients with advice to consistently and continuously monitor blood pressure levels, staying on top of their numbers to stay involved in their treatment.

“For patients, I think the biggest thing you could say is something we’ve been saying: check it, change it, know your numbers,” Patel suggested. “The greatest prevention we can have is knowledge about what we have, and that might make it much easier to prevent the complications of it.”

Editor's Note: Patel reports disclosures with Bayer Pharmaceuticals, Janssen Pharmaceuticals, and Novartis.

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