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 commentary from the European Renal Best Practice (ERBP)

Figure 1:. The leading causes of cardiovascular death and DALYs globally along with the changes in distribution between 2010 and 2023. Data from the 2023 Global Burden of Disease Study [1, 9]. Definitions: high SBP: >105–115 mmHg in adults >25 years of age; high LDL-cholesterol >0.9–1.4 mmol/L (35–54 mg/dL) in adults >25 years of age; high BMI: >20–22.5 kg/m2 in adults >20 years of age; high FPG >4.9–5.3 mmol/L (88–95 mg/dL) in adults >25 years of age; kidney dysfunction: eGFR ≤60 mL/min/1.73 m2. LDL, low-density lipoprotein; FPG, fasting plasma glucose; BMI, body mass index; LBW, low birth weight; SGA, short for gestational age; DALY, disability-adjusted life year.

Figure 2:. Values of SBP/DBP for HBPM and ABPM corresponding to office SBP and DBP levels. Note that HBPM and daytime ABPM share the same values. Graph designed using data from Table 7 in Jones et al. [3].

Figure 3:. BP thresholds to diagnose hypertension and therapeutic targets in recent clinical guidelines for CKD patients. All guidelines basically agree on who should be treated with medication for high BP and agree on a common target for SBP (<130 mmHg) and DBP (<80 mmHg) for most, and that therapy and BP targets should be individualized according to clinical situation, cardiovascular risk, and patient frailty or age. However, there are differences in nomenclature and on the recommendation for aiming to lower SBP below 120 mmHg. The 2025 ACC/AHA guideline considers hypertension at any SBP/DBP level that may require treatment with pharmacotherapy (i.e. ≥130 or ≥80 mmHg) and recommends pharmacotherapy for hypertension independently of the presence of high cardiovascular risk. However, 2024 ESC and 2023 ESH use alternative terms (high normal or elevated BP) for BP values (i.e. ≥130–139 or ≥80–89 mmHg) that require pharmacotherapy in high-risk groups. 2024 KDIGO avoids any controversy by avoiding the term hypertension altogether, emphasizing that BP targets refer to standardized office BP measurement. Color coding of images: burgundy represents hypertension, orange represents elevated or high…