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Recent updates to blood pressure (BP) guidelines published in the Journal of the American College of Cardiology have lowered the threshold for initiating hypertension treatment among low-risk patients. According to the 2025 joint guideline from the American Heart Association and the American College of Cardiology, adults without clinical cardiovascular disease (CVD) and with an estimated 10-year CVD risk below 7.5% should begin antihypertensive therapy if their average systolic BP remains at 130 mm Hg or above or diastolic BP remains at 80 mm Hg or above after 3–6 months of lifestyle interventions. The new thinking is expected to expand eligibility for drug therapy among individuals with early stage hypertension and replaces the previous guideline from 2017. Additionally, the updated guideline shifts to the use of new, more accurate risk equations to determine the 7.5% cutoff. The PREVENT tool combines measures of cardiovascular, kidney and metabolic health for more precise risk estimates for cardiovascular disease, according to the authors. Other recommendations from the groups include initiating antihypertensive medication in pregnant women with chronic hypertension and a moderate recommendation for all adults to consider potassium-based salt substitutes.
All things considered: The new guidelines were endorsed by 11 professional medical societies, and a graphic is available online. Even so, for low-risk individuals with stage 1 hypertension, shared decision-making between patients and providers will likely be an important factor when considering whether to write a prescription for antihypertensives.
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