Blood Pressure Categories & Treatment Targets
The guideline retains the 2017 definitions of blood pressure categories:
- Normal: < 120/80 mm Hg
- Elevated: 120–129 / < 80 mm Hg
- Stage 1 Hypertension: 130–139 or 80–89 mm Hg
- Stage 2 Hypertension: ≥ 140 or ≥ 90 mm Hg
The treatment goal for all adults remains < 130/80 mm Hg.
Risk Assessment & Personalized Care
The new PREVENT™ risk calculator replaces the older pooled cohort equations. It estimates both 10- and 30-year cardiovascular risk and integrates cardiovascular, kidney, metabolic, and social health factors to personalize interventions.
Prevention, Lifestyle & Brain Health
The guideline emphasizes prevention of heart disease, stroke, kidney disease, and cognitive decline.
Lifestyle recommendations include:
- Sodium intake < 2,300 mg/day (ideal < 1,500 mg)
- DASH-style or heart-healthy diet
- 75–150 minutes/week of aerobic and/or resistance activity
- ≥ 5% weight loss if overweight
- Stress management with meditation, breathing exercises, or yoga
- Alcohol limitation: maximum 2 drinks/day (men), 1 (women)
Diagnostics & Laboratory Evaluation
- Urine albumin-to-creatinine ratio is now recommended for all hypertensive patients to assess kidney health.
- Plasma aldosterone-to-renin ratio screening is expanded to detect primary aldosteronism, especially in resistant hypertension or sleep apnea.
Medication Strategy
- Stage 2 hypertension: Start with two medications, preferably as a single-pill combination.
- Recommended classes: ACE inhibitors, ARBs, long-acting dihydropyridine CCBs, and thiazide-type diuretics.
- In patients with overweight or obesity, GLP-1 receptor agonists may be considered as an adjunct.
Special Considerations: Hypertension in Pregnancy
- Initiate antihypertensive therapy when BP reaches ≥ 140/90 mm Hg.
- Postpartum women with pregnancy-associated hypertension should have annual BP checks.
Low-dose aspirin (81 mg/day) may be considered to reduce the risk of preeclampsia.