The American Heart Association released its latest hypertension guideline in August 2025, establishing best practices for diagnosing and managing a disease that remains the leading preventable cause of death worldwide and a major contributor to mortality in the United States. The new guideline calls for tighter blood pressure control, expanded use of home monitoring, more precise risk assessment tools, and stronger team-based care.
Dr. Yvonne Commodore-Mensah, associate dean for research at the Johns Hopkins School of Nursing, contributed her expertise to shaping the guideline. Below, she shares what’s new in hypertension care.
Why does the 2025 guideline call for earlier treatment of high blood pressure—even at lower thresholds—and how might this shift affect clinical practice?
The most recent guidelines reflect what decades of research have shown: cardiovascular damage doesn’t wait until blood pressure reaches 140/90. The damage starts much earlier.
In fact, evidence from the SPRINT trial showed that treating blood pressure to below 120 systolic reduced cardiovascular events by about 25%. That’s why now “normal” is defined as less than 120/80. Elevated blood pressure is 120–129 systolic, with diastolic still under 80. Stage 1 hypertension is 130–139 systolic or 80–89 diastolic.
For nurses, this means identifying and counseling patients earlier. Someone in the 121–130 range, who might have been told they were “normal” before, now needs closer monitoring and more aggressive lifestyle interventions. Depending on family history or comorbidities like diabetes, medications may even start sooner. Education and consistent follow-up are essential to help patients understand these risks and take steps toward prevention.
How is high blood pressure linked to cognitive decline and dementia, and what strategies can nurses use to help monitor and protect brain health?
One of the most important updates in the 2025 guideline is the stronger evidence linking high blood pressure to cognitive decline and dementia. Controlling blood pressure doesn’t just protect the heart and kidneys—it protects the brain.
The brain is highly vascular. Just as elevated blood pressure damages the vessels in the heart or kidneys, it damages the vessels that supply the brain. Over time, that results in problems with memory, multitasking, or word-finding—small but progressive changes. And unlike dialysis for kidney failure, there’s no “transplant” or cure for dementia. By the time symptoms appear, it’s often too late. That’s why prevention is critical.
What new tools does the guideline introduce for prevention, and how will they improve accuracy, personalization, and early intervention in blood pressure care?
The PREVENT™ risk calculator is a major step forward in how we think about prevention. Unlike older models, it doesn’t just estimate short-term risk of heart attack or stroke. It projects both 10- and 30-year risks of cardiovascular disease, heart failure, and stroke, which gives us a much clearer view of how hypertension and related factors affect people across their lifetime.
What makes PREVENT especially important is the inclusion of newer predictors. Kidney function, measured through estimated glomerular filtration rate (eGFR), is now factored in—critical because high blood pressure and kidney disease go hand in hand. The other innovation is the social deprivation index. By incorporating data tied to ZIP code, PREVENT accounts for neighborhood-level factors like housing stability, food access, employment, and community resources.
That shift matters because it recognizes that a person’s environment can be just as influential as their genetics. Two patients with the same blood pressure reading may face very different risks depending on where they live. PREVENT allows us to capture those differences and intervene earlier. For nurses, it provides a tool to frame conversations around both clinical numbers and social realities, guiding more personalized care plans and reinforcing the need for advocacy around equity in hypertension management.
What does effective team-based care look like in practice when the goal is to meet patients where they are? What role do nurses play in making that approach successful?
Team-based care received one of the highest levels of recommendation in the 2025 guideline. Hypertension is not only too prevalent—affecting about 120 million Americans—but also too complex for any single clinician to manage. Effective care requires the unique strengths of each team member: primary care clinicians who can diagnose and prescribe; nurses for education, coordination, and health literacy; pharmacists for medication management; medical assistants for accurate measurement; dietitians for culturally tailored nutrition guidance; and community health workers to address social needs such as housing, food, or employment.
Nurses are central to holding this model together—coordinating across providers, ensuring patients understand treatment, adapting education to literacy and culture, and extending engagement into community settings. Flexible approaches, like remote support from community health workers and pharmacists with telehealth and mobile apps, are proving especially important for patients balancing jobs, childcare, or unstable housing. This coordination and flexibility can mean the difference between uncontrolled and well-managed blood pressure.
Forward through policy
Hypertension (high blood pressure) is the leading preventable cause of death globally and a primary or contributing cause of death in the United States.
Policy is as critical to hypertension control as clinical care. For example, Maryland’s recent law providing Medicaid patients with home blood pressure devices is one example of how legislation, in alignment with the American Heart Association’s hypertension guideline, can remove barriers and expand access. But such measures are far from universal.
Nurses have a powerful role to play beyond the bedside—using their expertise to educate lawmakers, push for equitable policies, and ensure that every community has the tools and resources needed for prevention and control. This is where nursing leadership drives systemic change.
References
American Heart Association. Top 10 things to know about the new AHA/ACC high blood pressure guideline. August 14, 2025. heart.org/en/health-topics/high-blood-pressure/the-facts-about-high-blood-pressure/high-bp-top-10
Writing Committee Members*; Jones DW, Ferdinand KC, et al. 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 Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Hypertension. 2025;82(10):e212-316. doi:10.1161/HYP.0000000000000249
