Updated Hypertension Guidelines Are Here

Approximately half of US adults are living with hypertension.¹ Updated guidelines for hypertension were published in August 2025 by organizations including the American College of Cardiology and the American Heart Association (AHA), with pharmacotherapy and lifestyle recommendations.² Pharmacists can incorporate the updated hypertension guidelines through their medication therapy management (MTM) practices.

MTM and Updated Hypertension Guidelines

During MTM consults, pharmacists can integrate the new hypertension guidelines into clinical practice while managing patients' hypertension. Prevention and early treatment to lower the risk of cardiovascular disease (CVD) are top features of the updated guidelines.²

The AHA Predicting Risk of Cardiovascular Disease Events (PREVENT) risk calculator was incorporated into the new guidelines to help determine when to start antihypertensive medications.² This calculator estimates CVD risk in patients and provides updated recommendations (see Table²).

Managing hypertension during pregnancy is also a priority, and the guidelines include new recommendations. Patients with hypertension who are pregnant or planning to become pregnant should be educated about the use of low-dose aspirin to prevent preeclampsia.² Additionally, pregnant patients with a systolic blood pressure (SBP) of 140 to 159 mm Hg and/or diastolic blood pressure (DBP) of 90 to 109 mm Hg prior to 20 weeks' gestation should receive antihypertensive medications.² The goal is to bring down the blood pressure to less than 140/90 mm Hg.

The first-line medications during pregnancy are labetalol and extended-release nifedipine.² The typical starting dose of labetalol is 100 to 200 mg twice daily, and the recommended dosage ranges from 200 to 2400 mg/d in 2 to 3 divided doses.² Labetalol should be avoided in patients with certain conditions, such as asthma, bradycardia, heart block, decompensated cardiac function, and preexisting myocardial disease. The nifedipine starting dosage is generally 30 to 60 mg once daily.² The daily recommended dosage typically ranges from 30 to 120 mg.² Nifedipine immediate release should be reserved for hospitalized patients with severe hypertension, and sublingual nifedipine should be avoided to prevent hypotension and fetal problems.

Pharmacists can play an important role in managing severe hypertension during pregnancy, which is defined as SBP of 160 mm Hg or greater, or DBP of 110 mm Hg or greater.² Patients experiencing severe hypertension should receive antihypertensive medications within 30 to 60 minutes to prevent serious complications such as preterm birth, perinatal death, and maternal death.²

Important lifestyle modifications were added to the new guidelines. Pharmacists can counsel patients about lifestyle changes during MTM consults. Avoiding alcohol or limiting it to 1 or fewer drinks for women and 2 or fewer drinks for men per day are part of the new recommendations, given that alcohol increases systolic blood pressure.²

An additional lifestyle change is using potassium-based salt substitutes in adults with or without hypertension. These can prevent or treat elevated blood pressure and hypertension, especially when salt is added during food preparation.² However, patients with chronic kidney disease or those taking medications that reduce potassium excretion (eg, potassium-sparing diuretics) may need additional monitoring while using potassium-based salt substitutes to prevent hyperkalemia.²  

Dementia is another focus of the new guidelines. Evidence suggests that hypertension is a modifiable risk factor for cognitive impairment and dementia.² The goal SBP is less than 130 mm Hg to prevent mild cognitive impairment and dementia in adult patients with hypertension.² One of the complications of hypertension is cerebrovascular disease, which is commonly seen in Alzheimer disease and similar forms of dementia.

MTM Spotlight

In an email interview with Pharmacy Times, Andrea Levin, PharmD, CPh, BCACP, an associate professor in the Department of Pharmacy Practice at the Barry and Judy Silverman College of Pharmacy at Nova Southeastern University in Davie, Florida, discussed strategies to incorporate the updated hypertension guidelines into practice. Levin practices at an ambulatory care clinic where she manages patients' hypertension and recently provided a hypertension lecture to pharmacy students that highlighted the new guidelines.

“Key takeaways from the guidelines include using the PREVENT risk calculator, avoiding alcohol, and initiating pharmacotherapy earlier in pregnant patients. Tighter control of blood pressure during pregnancy is critical to prevent adverse maternal and perinatal outcomes,” Levin said. These critical guideline updates are an important part of Levin’s clinical practice site and training for pharmacy students on their advanced pharmacy practice experiences.

About the Author

Jennifer Gershman, PharmD, CPh, PACS, is a drug information pharmacist and Pharmacy Times contributor who resides in South Florida.

REFERENCES

1. Estimated hypertension prevalence, treatment, and control among U.S. adults. Million Hearts. Updated May 12, 2023. Accessed October 9, 2025. https://millionhearts.hhs.gov/data-reports/hypertension-prevalence.html

2. Writing Committee members; 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. Hypertension. 2025;82(10):e212-e316. doi:10.1161/HYP.0000000000000249