Hypertension International Guidelines: Three of a Kind?

In August 2025, the new “Guidelines for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults” [ 1 ], as a result of a joint effort by the American Heart Association (AHA)/American College of Cardiology (ACC)/American Association of Nurse Practitioners/American Academy of Physician Assistants/Association of Black Cardiologists/American Association of Colleges of Pharmacy/ American College of Preventive Medicine/American Geriatrics Society/American Medical Association/American Society for Preventive Cardiology were published on Circulation and Hypertension [ 1 ]. The US guidelines follow the 2023 European “Guidelines for the management of arterial hypertension” from the European Society of Hypertension (ESH) [ 2 ], endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH), and the 2024 “Guidelines for the management of elevated blood pressure and hypertension” [ 3 ] of the European Society of Cardiology (ESC) endorsed by the European Society of Endocrinology (ESE) and the European Stroke Organisation (ESO). At the pace of one major international guideline per year, it appears clear the relevance that arterial hypertension holds in the global healthcare landscape. On the other hand, these multitude of documents may generate confusion especially when they deliver different recommendations. Diseases partially driven by environmental factors, lifestyle habits and stressors, such as hypertension, may certainly imply geographical differences. Indeed, using the same blood pressure (BP) diagnostic criteria (the European ones), the prevalence of arterial hypertension in Europe is 37% [ 4 ], while in the US it is 46% [ 5 ]. Thus, the development of new US guidelines is definitely appropriate, especially when considering that the previous document was issued 8 years before [ 6 ]. Nevertheless, it is interesting to see if, and where, these new guidelines compared to the two almost contemporary European documents differ in their general approach and in a number of recommendations. In fact, it appears puzzling why, in the presence of the same available scientific evidence, the documents produced may produce multiple relevant differences and deliver different recommendations to the medical community.