KDOQI Commentary on the 2025 AHA/ACC Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults

Hypertension prevention, diagnosis, and management are central to modifying the progression of chronic kidney disease (CKD). Although the nephrology community has long recognized CKD as an independent risk factor for cardiovascular disease, CKD has not historically been incorporated in cardiovascular risk prediction models. The new 2025 American Heart Association and American College of Cardiology (AHA/ACC) Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults addresses this gap by formally adopting the PREVENT calculator, which combines cardiovascular, kidney, and metabolic health parameters to guide risk assessment and clinical decision making. The AHA/ACC guideline reinforces the broad blood pressure target of <130/80 mm Hg as well as makes recommendations for complex and resistant hypertension. Given the impact of these recommendations on persons living with kidney disease, the Kidney Disease Outcomes Quality Initiative (KDOQI) convened an expert work group to review and comment on the guideline. This KDOQI commentary focuses on recommendations from the AHA/ACC guideline that are pertinent to individuals at risk of CKD or with non-dialysis-dependent CKD (stages 1-5), hence excluding commentary on hypertension management in patients receiving maintenance dialysis. In areas where the AHA/ACC guideline does not offer formal recommendations (eg, medication interactions, electrolyte imbalances, and kidney injury), the work group provides expert commentary about implications for people with CKD. Overall, the work group supports the majority of the AHA/ACC recommendations and identifies areas where evidence remains limited or management in CKD warrants additional consideration.