Hypertension Prevention, Detection, and Management: Guidelines From the AHA/ACC

Michael J. Arnold

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Primary Care Hypertension Management: Guidelines From Hypertension Canada

Practice Guidelines

Hypertension Prevention, Detection, and Management: Guidelines From the AHA/ACC

Michael J. Arnold, MD, MHPE

American Family Physician. 2026;114(4):432-435.

Author Disclosure: No relevant financial relationships.

This clinical content conforms to AAFP criteria for CME.

See related Practice Guideline, Primary Care Hypertension Management: Guidelines From Hypertension Canada.

• Lifestyle interventions are recommended for all adults for hypertension prevention and treatment.

• Start medical treatment at an average systolic BP of 140 mm Hg or greater or diastolic BP of 90 mm Hg or greater for all patients and at an average systolic BP of 130 mm Hg or greater for patients with cardiovascular risk factors or inadequate response to lifestyle interventions.

• For most patients, use a two-drug combination comprising an ACE inhibitor or ARB with a thiazide-type diuretic or long-acting dihydropyridine CCB for medical treatment.

• The primary treatment target is systolic BP less than 130 mm Hg, with encouragement to reach systolic BP less than 120 mm Hg and diastolic BP less than 80 mm Hg.

• For patients with resistant hypertension, screen for primary aldosteronism and, if positive, consider imaging of the adrenal glands and add a mineralocorticoid receptor agonist such as spironolactone.

• Orthostatic hypotension in patients with hypertension improves with BP control.

Hypertension affects as many as 90% of adults at some time in their life and often coexists with other cardiovascular risk factors such as chronic kidney disease, diabetes, obesity, and smoking. The risk of cardiovascular events approximately doubles with every 20 mm Hg increase in systolic blood pressure (BP) and every 10 mm Hg increase in diastolic BP. The American Heart Association/American College of Cardiology (AHA/ACC), in collaboration with 11 other organizations (but not the American Academy of Family Physicians), released updated guidelines for prevention, detection, and management of hypertension in adults.

GUIDELINE SUMMARY

BP Assessment

Office. Given the tendency for manual (auscultatory) BP measurement to falsely elevate BP values or otherwise be inaccurate due to the need for regular recalibration, validated oscillometric devices are recommended for office BP assessment following a specific protocol. This protocol includes patient avoidance of caffeine, exercise, and smoking for at least 30 minutes before measurement and the patient having an empty bladder.

Other key elements of the protocol include the patient sitting with feet on floor, legs uncrossed, and with the back supported for more than 5 minutes; use of a correctly sized cuff placed at heart level on a supported bare arm; no talking during the rest or measurement periods; no use of a cell phone by the patient; and two or more readings taken at least 1 minute apart.

Out of Office. Ambulatory (using a portable machine that monitors BP over 24 hours) and home BP monitoring are useful in confirming suspected hypertension. When using a home BP device, two measurements should be taken in the morning before the patient eats and with an empty bladder, and two measurements taken before bedtime. Neither type of monitoring has been shown to be superior; both are more predictive of outcomes than in-office assessment. Results of home BP monitoring may be more reproducible than those with other methods, and home monitoring can be used to guide medication dose titration.

MICHAEL J. ARNOLD, MD, MHPE, FAAFP, is the officer in charge at the Naval Undersea Medical Institute, Groton, Connecticut; an associate professor of family medicine at the Uniformed Services University of the Health Sciences F. Edward Hébert School of Medicine, Bethesda, Maryland; and an AFP assistant medical editor.

Address correspondence to Michael J. Arnold, MD, MHPE, at mkcarnold@gmail.com.

Author Disclosure: No relevant financial relationships.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Michael J. Arnold, MD, MHPE, AFP Assistant Medical Editor.

A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide.