The 2025 Hypertension guidelines are out! The alphabet soup of groups that contributed to the guidelines are as follows: AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM – I didn’t make that up! I made my way through the guidelines and wanted to share 4 important points that pharmacists should remember about the 2025 hypertension guidelines.
Hypertension’s link to cognitive decline and dementia is given greater weight in the new guideline—prompting earlier intervention even in milder cases. The guidelines help provide us pharmacists who work in geriatrics with a little more emphasis on the importance of blood pressure control. I’ll keep this in mind, especially in our patients with mild to moderate dementia.
GLP-1 agonists make the list of important things to note in the 2025 hypertension guidelines. Guidelines mention considering using GLP-1 receptor agonists for patients with obesity, addressing both BP and metabolic control. Weight loss can be an important intervention to allow our patients to maintain a healthier blood pressure. Non-drug interventions/lifestyle changes are heavily emphasized as well, which I love!
In patients with stage 2 hypertension (≥ 140/90), starting with two agents in a single-pill combination is still recommended. I’ve seen firsthand how effective this can be in practice, as patients tend to do better when they have fewer pills to take. In addition to improved adherence, using two mechanisms can be helpful in providing a more robust response as well as allowing us to use lower doses and hopefully encounter fewer adverse effects. The first line drug classes include thiazide diuretics, ACEI or ARBs, and calcium channel blockers (must know for board exams!)
A new tool, PREVENT (Predicting Risk of cardiovascular disease EVENTs), estimates 10- and 30-year CVD risk. ASCVD risk calculators only estimated the 10-year risk. This risk stratification tool can help guide patients and clinicians on how aggressive to be when choosing whether or not to start or increase medications.
What did I miss, and what is important in your practice?
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