2025 AHA/ACC blood pressure guideline and HEARTS 2.0: implications for the future evolution of integrated cardiovascular–kidney–metabolic care in the Americas

Hypertension is the leading modifiable risk factor for cardiovascular disease. In 2025, two major evidence-based frameworks evolved in parallel: HEARTS 2.0, an implementation-oriented clinical pathway for integrated cardiovascular–kidney–metabolic (CKM) care through primary health care, and the updated American Heart Association/American College of Cardiology Blood Pressure Guideline, one of the world's leading hypertension guidelines. Although developed for different intended applications, both drew on a common and rapidly expanding evidence base, making it timely to examine their areas of convergence and divergence. Using the four operational domains of the HEARTS 2.0 Clinical Pathway, this article compares both approaches and examines their implications for the future evolution of integrated CKM care in the Americas. The analysis demonstrates substantial concordance across all domains, including accurate blood pressure measurement, risk-based care, simplified treatment protocols with early use of single-pill combinations, rapid treatment intensification, team-based care, and comprehensive CKM risk reduction. The few remaining differences should not be viewed as contradictions but as opportunities for future refinement. They primarily concern the diagnostic threshold for hypertension, the application of blood pressure targets below 130/80 mmHg, and emerging cardiometabolic therapies. These areas reflect ongoing debates and evolving evidence that may inform future updates of HEARTS 2.0, with adoption varying across countries according to context, feasibility, affordability, and implementation capacity. Overall, this comparison reinforces the scientific foundations of both frameworks and supports their interpretation as complementary and mutually reinforcing approaches for advancing the implementation of scalable, integrated CKM care in the Americas.