Case-Based Applications of the 2025 AHA/ACC/Multispecialty High Blood Pressure Guideline

Hypertension affects nearly half of all adults in the United States and is the leading, preventable cause of cardiovascular disease worldwide. The American Heart Association, American College of Cardiology, and 11 other professional organizations recently published an updated 2025 guideline to reflect the latest advances in the prevention, detection, evaluation, and management of high blood pressure. To bridge the gap between this guideline update and individualized patient care, this Special Article presents 4 hypothetical cases of high blood pressure, focusing on management in the outpatient setting. These cases illustrate how to apply a risk-based approach to high blood pressure management that incorporates blood pressure levels, cardiovascular disease risk factors and the predicting risk of cardiovascular disease events cardiovascular disease equations. They also highlight notable updates in the 2025 guideline such as recommendations for lifestyle approaches, initiation of medications, blood pressure goals, primary aldosteronism screening, and management of high blood pressure before, during and after pregnancy. By contextualizing the 2025 guideline within these hypothetical case scenarios, this Special Article provides practical guidance to health care teams to offer the most up-to-date, evidence-based care of high blood pressure.