Nurses at the Forefront: Implementation of the Updated 2025 AHA/ACC Hypertension Guidelines

The release of the 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 represents a transformative moment for nursing care and leadership in cardiovascular prevention.1 This comprehensive update replaces the 2017 guidelines and incorporates evidence-based recommendations that position nurses at the forefront of hypertension management innovations. The guidelines present and apply the American Heart Association (AHA)/American College of Cardiology (ACC) Class (strength) of Recommendation and Level (quality) of Evidence that were updated in 2024.1 For cardiovascular nurses, these guidelines present both opportunities and responsibilities to lead and contribute to cardiovascular care advances that can dramatically improve outcomes for the nearly half of American adults living with hypertension.2 Notably, the guidelines were developed in collaboration with and endorsed by the American Association of Nurse Practitioners and the Preventive Cardiovascular Nurses Association, reflecting the critical role nurses play in hypertension care.1,3 Expanding Patient Education: The Hypertension-Dementia Connection Perhaps the most significant development for nursing practice is the strengthened evidence linking hypertension to cognitive decline and dementia.1,4 The guidelines now provide stronger evidence that high BP is linked to increased risk of cognitive decline, fundamentally changing how nurses could approach patient education conversations. The guidelines recommend an aggressive systolic BP goal of <130 mm Hg for adults with hypertension to prevent mild cognitive impairment and dementia (Class of Recommendation [COR] 1 B-R).1 This evidence transforms the traditional cardiovascular education model to include brain health.1 Clinicians are now recommended to provide patients with evidence-based counseling that hypertension control protects both cardiovascular and cognitive health. This includes incorporating cognitive health messaging into BP education and explaining that maintaining BP below 130/80 mm Hg today may prevent dementia in addition to cardiovascular disease (CVD) decades later in life.1 Advancing Technology Integration in Nursing Practice to Improve Blood Pressure Control The guidelines recommend that, “Home blood pressure monitoring combined with frequent interactions with multidisciplinary team members using standardized measurement and treatment protocols is an important integrated tool to improve rates of BP control” (COR 1A).1 Thus, home BP monitoring is one of the most effective strategies that nurses can support to improve BP control rates in the U.S. Resources on appropriate home monitoring devices such as validatebp.org are provided and highlights an opportunity for nurses to teach patients device validation principles, proper cuff sizing, and optimal measurement techniques.1 In addition, the guidelines stress that reliance on cuffless devices, including smartwatches, for accurate BP measurements should be avoided until these devices demonstrate greater precision and reliability and are appropriately validated (COR 3 C-EO).1 The guidelines support nursing innovation in telehealth and remote monitoring programs.1,5 Nurse informaticists can develop protocols for patients to transmit home readings through patient portals or telehealth platforms, while clinical nurses can use this technology to identify concerning trends between office visits, adjust medications more rapidly within established protocols, and provide immediate feedback to patients. Nurses Leading the Implementation of Team-Based Hypertension Care Multidisciplinary team-based care is effective in assessing and addressing patient access to medications and other structural barriers to support individual patient needs and thereby reduce barriers to achieving hypertension control (COR 1 A).1 The guidelines specifically recognize that team members may include physicians, pharmacists, nurse practitioners, nurses, physician assistants/associates, dietitians, community health workers, and other health care professionals.1 This recognition further elevates nursing’s role in coordinating comprehensive hypertension care. Nurse managers and nurse leaders are often best positioned to serve as implementation facilitators and coordinating care across disciplines, while identifying barriers to medication adherence, lifestyle modification challenges, and social determinants affecting BP control.6 Advanced practice nurses can lead the implementation of systematic hypertension treatment protocols. Clinical nurses can implement lifestyle modification counseling protocols while collaborating with community health workers to connect patients with community resources. The guidelines support nurse-led hypertension clinics where advanced practice nurses can assume primary responsibility for ongoing hypertension management within established protocols. Implementing the PREVENT Equation in Nursing Practice The PREVENT (Predicting Risk of CVD EVENT) risk equations estimate 10- and 30-year risk for total CVD, including atherosclerotic CVD and heart failure (HF), a notable shift from previous risk calculators that only focused on atherosclerotic CVD.7,8 The PREVENT equation is the first risk tool to combine cardiovascular, kidney, and metabolic health measures to guide primary prevention-focused treatment decisions.7,8 Nurse practitioners must become proficient in using the PREVENT calculator and interpreting results for patient education and clinical decision-making. Clinical nurses need training on how the calculator integrates kidney function measures (urine albumin-creatinine ratio) and social determinants of health (Social Deprivation Index), creating opportunities for more comprehensive nursing assessments. Advancing Pregnancy-Related Hypertension Care Treatment with certain medications is recommended for pregnant women with chronic hypertension when systolic and/or diastolic BP levels reach 140/90 mm Hg or higher (COR 1A).1,9 This represents a significant shift toward tighter BP control during pregnancy, with important implications for nursing care across multiple settings. Early detection, diagnosis, and treatment of high BP during pregnancy is imperative given the increased risk of developing chronic hypertension and overt cardiovascular and cerebrovascular morbidity and mortality.1,10 This knowledge enables nurses to provide comprehensive counseling about both immediate pregnancy risks and long-term clinical implications. Nurse midwives and women’s health nurse practitioners are particularly well-positioned to lead implementation of these new recommendations. Unchanging Cornerstone: Nurse-Led Lifestyle Modification Lifestyle modification remains the cornerstone of hypertension control (COR 1A), and nurses are essential in translating this robust evidence into successful patient outcomes. Comprehensive lifestyle changes (eg, DASH diet, sodium reduction, physical activity, stress management) are strongly recommended for all adults with elevated BP or hypertension (COR 1A).1 Moving beyond generic advice, nurses must develop and implement individualized, comprehensive wellness plans that incorporate stress management, sleep hygiene, and social determinants of health to ensure equitable access to resources for sustained change.2,11 Counseling should include all proven lifestyle strategies: adopting a heart-healthy eating pattern (eg, DASH diet), reducing sodium intake, increasing physical activity, and addressing psychosocial wellness.1,12 The guidelines also introduce a specific, practical dietary approach by stating that potassium-based salt substitutes are a reasonable option (COR 2A) for preventing or treating elevated BP, particularly when salt intake is related to home food preparation.1 Nurses should include education on these substitutes as a dietary tool, but must carefully assess for contraindications, such as chronic kidney disease or the use of potassium-sparing medications.1 Conclusion The 2025 AHA/ACC hypertension guidelines provide a roadmap for nurses to lead in CVD prevention. Successful outcomes depend not just on the recommendations themselves, but on the systematic effort to translate these evidence-based principles into effective clinical practice. Nurses are uniquely positioned to lead this translation, from educating patients about the hypertension-dementia connection to championing PREVENT-guided care and technology integration. The strong emphasis on team-based care aligns perfectly with nursing’s holistic approach, enabling a transformation of hypertension management from a model of episodic, provider-centric care to a patient-centered nurse-coordinated, continuous prevention approach that addresses the full spectrum of cardiovascular risk factors.