New Hypertension Guideline: Key Shifts for Pharmacists

In an interview with Pharmacy Times, Stacey M. Cutrell, PharmD, BCACP, CDCES, a clinical pharmacist practitioner in the family medicine department at UNC Health, discussed the most practice-changing updates in the 2025 American College of Cardiology/American Heart Association hypertension guideline and how pharmacists can distinguish resistant hypertension from secondary causes before escalating therapy. The discussion was based on a presentation by Cutrell at the Association of Diabetes Care and Education Specialists 2026 Annual Meeting in Columbus, Ohio, titled “When Blood Pressure Won’t Budge: Managing Resistant Hypertension in People with Diabetes.”

Cutrell highlighted the adoption of the PREVENT risk calculator, which replaces the pooled cohort equations and, she noted, draws on larger and more contemporary data to provide a broader assessment of cardiovascular risk. She explained that the calculator now informs treatment decisions in stage 1 hypertension: after calculating a patient's risk score, a result of 7.5% or greater supports initiating blood pressure medication. Cutrell also pointed to a renewed emphasis on identifying secondary hypertension—present in the 2017 guideline but expanded here, particularly around primary aldosteronism—aimed at addressing the underdiagnosis of secondary causes. A third major update, she said, is more detailed guidance for special populations, including individuals with chronic kidney disease, diabetes, pregnancy, and neurologic conditions.

Turning to resistant hypertension, Cutrell described the guideline's stepwise framework. She defined resistant hypertension as blood pressure that remains elevated despite the use of 3 antihypertensive medications or blood pressure at goal that requires 4 or more agents. Once resistant hypertension is identified, she said, pharmacists should screen for secondary causes, because these are highly prevalent in this population. Cutrell emphasized screening early given how challenging secondary causes can be to distinguish and stressed that positive screens warrant referral to clinicians with expertise in the specific secondary cause to confirm the diagnosis and guide management. For pharmacists, these updates translate into concrete roles: applying the PREVENT calculator to guide stage 1 treatment decisions, recognizing when a patient meets the definition of resistant hypertension, and ensuring timely screening and referral for secondary causes rather than reflexively escalating therapy.