ACC/AHA 2017 hypertension guideline: key recommendations

Official guideline2025 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. AHA/ACC, 2025.
Read the official guideline · Checked for a newer edition on 2026-10-20
We do not reproduce the guideline text — this page is an independent summary.

Who it applies to

Adults with or at risk of elevated blood pressure in outpatient, primary care, and cardiology settings, including considerations for older adults and those with comorbidities.

Key recommendations

Blood pressure should be measured using a standardized technique with proper patient preparation, and out-of-office measurement (home or ambulatory monitoring) is recommended to confirm diagnosis and rule out white-coat or masked hypertension.
Hypertension is redefined as blood pressure at or above 130/80 mmHg, lowering the threshold from the previous 140/90 mmHg cutoff.
Lifestyle modification, including dietary sodium reduction, a heart-healthy eating pattern such as DASH, weight loss, physical activity, and limiting alcohol, is recommended as first-line therapy for all patients with elevated blood pressure or stage 1 hypertension.
Pharmacologic treatment decisions should incorporate estimated cardiovascular risk, with drug therapy recommended for stage 1 hypertension when calculated 10-year atherosclerotic cardiovascular disease risk is elevated, and for all patients with stage 2 hypertension.
A blood pressure target below 130/80 mmHg is recommended for most adults with confirmed hypertension, including many older adults, based on evidence that lower targets reduce cardiovascular events.
Initial pharmacologic therapy may start with two first-line agents from different classes (such as a thiazide-type diuretic, ACE inhibitor or ARB, or calcium channel blocker), particularly when baseline blood pressure is well above goal.
Use of single-pill combination therapy is encouraged to improve adherence and achieve blood pressure control more efficiently than sequential monotherapy.
Patients with resistant hypertension should be evaluated for secondary causes, medication adherence issues, and consideration of a mineralocorticoid receptor antagonist as add-on therapy.
Screening for secondary hypertension, including primary aldosteronism, is recommended in patients with resistant hypertension, significant hypokalemia, or an adrenal incidentaloma.
Routine follow-up intervals and team-based care models, including pharmacist and nurse-led protocols, are recommended to improve long-term blood pressure control.

What is new in this edition

Lowering of the diagnostic threshold for hypertension to 130/80 mmHg from the prior 140/90 mmHg cutoff
Introduction of formal cardiovascular risk calculator use into the decision to start drug therapy in stage 1 hypertension
New staging system replacing prehypertension with elevated blood pressure and stage 1/stage 2 categories
Greater emphasis on out-of-office blood pressure measurement to confirm diagnosis

Practice points for students

Confirm any office blood pressure reading with home or ambulatory monitoring before labeling a patient hypertensive.
Remember the diagnostic threshold is 130/80 mmHg, not 140/90 mmHg, a frequent point of confusion with older guidelines.
Patients starting medication with substantially elevated blood pressure may begin on two drugs from different classes rather than one.
Think about primary aldosteronism in resistant hypertension, especially with hypokalemia or an adrenal mass.

Condition

Hypertension