By David G. Harrison and Rhian M. Touyz
This issue of Hypertension features the 2025 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for the Diagnosis and Treatment of Hypertension, developed by the Joint Committee on Clinical Practice Guidelines in collaboration with major stakeholders in health care and hypertension management.1 This document is essential reading for physicians and health care providers who care for patients with hypertension and related conditions, as it not only updates state-of-the-art, evidence-based care but also explores emerging concepts in the pathophysiology of the disease. Several important and unique aspects of this Guideline warrant emphasis, particularly in terms of risk assessment, treatment recommendations, and implementation. The 2025 ACC/AHA Guideline replaces the 2017 iteration, with some new and some revised recommendations from the previous version.
One of the major new recommendations in the 2025 Guideline is the emphasis on screening for hyperaldosteronism in all patients with resistant hypertension, regardless of their serum potassium levels. This reflects the growing evidence that up to one-third of patients with resistant hypertension have hyperaldosteronism and could benefit from targeted interventions, including surgical procedures or pharmacological therapies that interrupt the aldosterone pathway. Guidelines for diagnosing hyperaldosteronism have been published elsewhere and initial screening typically involves measuring aldosterone, renin, and potassium levels. Interestingly, the 2024 European Society of Cardiology Guideline for the management of elevated blood pressure and hypertension and the 2025 Endocrine Society primary aldosteronism clinical practice guideline recommend that all patients with hypertension, not just those with resistant forms, be screened for hyperaldosteronism. This broader approach highlights the underdiagnosis of the condition and its known contribution to poorly controlled and resistant hypertension.
Another important new recommendation relates to renal denervation as a therapeutic option in patients with resistant hypertension. Patients who are being considered for renal denervation need to be evaluated by a multidisciplinary team with expertise in resistant hypertension and renal denervation. Patients need to be informed of the potential procedural risks, and decisions need to be shared between patients and their physician in selecting renal denervation as an alternative to medical therapy.
The latest Guideline also includes new recommendations focused on specific patient groups, including those with acute intracerebral hemorrhage, pregnancy, hypertensive emergencies, and severe hypertension in nonpregnant, nonstroke patients. Readers are directed to the full text for further details.
For the complete journal visit: https://www.ahajournals.org/doi/epub/10.1161/HYPERTENSIONAHA.125.25467