Interpretation to the key points of the 2025 AHA/ACC guideline for the prevention, detection, evaluation and management of high blood pressure in adults_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SUN Qin ¹ , LI Aiai ¹ , YU Jing ¹ , LI Dongze ¹ , ZHANG Haihong ¹ ,  ZHONG Yan ² ,  WAN Zhi ¹

1. Department of Emergency, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
2. Department of Medical Administration, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding?author：

ZHONG Yan, Email: wanzhi4115@wchscu.cn; WAN Zhi, Email: 48003240@qq.com

Keywords：

Adults; hypertension; cardiovascular disease; guidelines; interpretation

DOI：

10.7507/1007-4848.202510067

Video：

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Abstract Full text Figures/Tables Video References Cited by

The American Heart Association (AHA) and the American College of Cardiology (ACC), in collaboration with multiple professional organizations, jointly released the “Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults” in August 2025. Based on the latest evidence-based medical findings from February 2015 to January 2025, the guideline proposes an individualized treatment strategy grounded in total cardiovascular disease risk stratification, incorporates the novel PREVENT risk assessment model, lowers the medication initiation threshold and control targets for high-risk populations, and provides specific management recommendations for special populations. This article provides an interpretation of these updates and conducts a comparative analysis with the current status of hypertension prevention and treatment in China as well as Chinese guidelines, aiming to offer reference for hypertension control practices in China.

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1. Whelton SP, McEvoy JW, Shaw L, et al. Association of normal systolic blood pressure level with cardiovascular disease in the absence of risk factors. JAMA Cardiol, 2020, 5(9): 1011-1018.
2. Rapsomaniki E, Timmis A, George J, et al. Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1. 25 million people. Lancet, 2014, 383(9932): 1899-1911.
3. Weldegiorgis M, Woodward M. The impact of hypertension on chronic kidney disease and end-stage renal disease is greater in men than women: a systematic review and meta-analysis. BMC Nephrol, 2020, 21(1): 506.
4. GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1223-1249.
5. Forouzanfar MH, Liu P, Roth GA, et al. Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990-2015. JAMA, 2017, 317(2): 165-182.
6. Martin SS, Aday AW, Almarzooq ZI, et al. 2024 Heart Disease and Stroke Statistics: a report of US and global data from the American Heart Association. Circulation, 2024, 149(8): e347-e913.
7. Khan SS, Coresh J, Pencina MJ, et al. Novel prediction equations for absolute risk assessment of total cardiovascular disease incorporating cardiovascular-kidney-metabolic health: a scientific statement from the American Heart Association. Circulation, 2023, 148(24): 1982-2004.
8. Jaeger BC, Chen L, Foti K, et al. Hypertension statistics for US adults: an open-source web application for analysis and visualization of National Health and Nutrition Examination Survey data. Hypertension, 2023, 80(6): 1311-1320.
9. 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, 2025, 152(11): e114-e218.
10. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA 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 Task Force on Clinical Practice Guidelines. Hypertension, 2018, 71(6): e13-e115.
11. 中國高血壓防治指南修訂委員會, 高血壓聯盟(中國), 中國醫療保健國際交流促進會高血壓病學分會, 等. 中國高血壓防治指南(2024年修訂版). 中華高血壓雜志, 2024, 32(7): 603-700.Chinese Hypertension Guideline Revision Committee, Hypertension Alliance (China), Hypertension Branch of China International Exchange and Promotion Association for Medical and Healthcare, et al. Chinese guidelines for the prevention and treatment of hypertension (2024 revised edition). Chin J Hypertens, 2024, 32(7): 603-700.
12. Wang Z, Chen Z, Zhang L, et al. Status of hypertension in China: results from the China Hypertension Survey, 2012-2015. Circulation, 2018, 137(22): 2344-2356.
13. Muntner P, Shimbo D, Carey RM, et al. Measurement of blood pressure in humans: a scientific statement from the American Heart Association. Hypertension, 2019, 73(5): e35-e66.
14. Panagiotakos D, Antza C, Kotsis V. Ambulatory and home blood pressure monitoring for cardiovascular disease risk evaluation: a systematic review and meta-analysis of prospective cohort studies. J Hypertens, 2024, 42(1): 1-9.
15. Schwartz JE, Muntner P, Kronish IM, et al. Reliability of office, home, and ambulatory blood pressure measurements and correlation with left ventricular mass. J Am Coll Cardiol, 2020, 76(25): 2911-2922.
16. Shimbo D, Abdalla M, Falzon L, et al. Role of ambulatory and home blood pressure monitoring in clinical practice: a narrative review. Ann Intern Med, 2015, 163(9): 691-700.
17. Gumz ML, Shimbo D, Abdalla M, et al. Toward precision medicine: circadian rhythm of blood pressure and chronotherapy for hypertension - 2021 NHLBI workshop report. Hypertension, 2023, 80(3): 503-522.
18. Shimbo D, Artinian NT, Basile JN, et al. Self-measured blood pressure monitoring at home: a joint policy statement from the American Heart Association and American Medical Association. Circulation, 2020, 142(4): e42-e63.
19. Margolis KL, Asche SE, Bergdall AR, et al. Effect of home blood pressure telemonitoring and pharmacist management on blood pressure control: a cluster randomized clinical trial. JAMA, 2013, 310(1): 46-56.
20. McManus RJ, Mant J, Haque MS, et al. Effect of self-monitoring and medication self-titration on systolic blood pressure in hypertensive patients at high risk of cardiovascular disease: the TASMIN-SR randomized clinical trial. JAMA, 2014, 312(8): 799-808.
21. Zhang DY, Guo QH, An DW, et al. A comparative meta-analysis of prospective observational studies on masked hypertension and masked uncontrolled hypertension defined by ambulatory and home blood pressure. J Hypertens, 2019, 37(9): 1775-1785.
22. Shimbo D, Muntner P. Should out-of-office monitoring be performed for detecting white coat hypertension? Ann Intern Med, 2019, 170(12): 890-892.
23. Islam SMS, Chow CK, Daryabeygikhotbehsara R, et al. Wearable cuffless blood pressure monitoring devices: a systematic review and meta-analysis. Eur Heart J Digit Health, 2022, 3(2): 323-337.
24. Han M, Lee YR, Park T, et al. Feasibility and measurement stability of smartwatch-based cuffless blood pressure monitoring: a real-world prospective observational study. Hypertens Res, 2023, 46(4): 922-931.
25. Hu JR, Martin G, Iyengar S, et al. Validating cuffless continuous blood pressure monitoring devices. Cardiovasc Digit Health J, 2023, 4(1): 9-20.
26. Khan SS, Matsushita K, Sang Y, et al. Development and validation of the American Heart Association's PREVENT equations. Circulation, 2024, 149(6): 430-449.
27. Wright JT Jr, Williamson JD, Whelton PK, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med, 2015, 373(22): 2103-2116.
28. Bress AP, Bellows BK, King JB, et al. Cost-effectiveness of intensive versus standard blood-pressure control. N Engl J Med, 2017, 377(8): 745-755.
29. Guo X, Ouyang N, Sun G, et al. Multifaceted intensive blood pressure control model in older and younger individuals with hypertension: a randomized clinical trial. JAMA Cardiol, 2024, 9(9): 781-790.
30. Sundstr?m J, Arima H, Jackson R, et al. Effects of blood pressure reduction in mild hypertension: a systematic review and meta-analysis. Ann Intern Med, 2015, 162(3): 184-191.
31. Blood Pressure Lowering Treatment Trialists' Collaboration. Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis. Lancet, 2021, 397(10285): 1625-1636.
32. Karmali KN, Lloyd-Jones DM, van der Leeuw J, et al. Blood pressure-lowering treatment strategies based on cardiovascular risk versus blood pressure: a meta-analysis of individual participant data. PLoS Med, 2018, 15(3): e1002538.
33. Fuchs SC, Poli-de-Figueiredo CE, Figueiredo Neto JA, et al. Effectiveness of chlorthalidone plus amiloride for the prevention of hypertension: the PREVER-Prevention randomized clinical trial. J Am Heart Assoc, 2016, 5(12): e004248.
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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesInterpretation to the key points of the 2025 AHA/ACC guideline for the prevention, detection, evaluation and management of high blood pressure in adults

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