Cardiology · AHA

Hypertension in adults

AHA

Source:2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults

Verified Apr 2026

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Red Flags

BP ≥180/120 mmHg with end-organ involvement (chest pain, dyspnoea, neurological deficit, AKI) — hypertensive emergency requiring IV therapy^[1]
Sudden severe headache + BP elevation in pregnancy >20 weeks — preeclampsia/eclampsia^[2]
New BP ≥160/100 in a previously normotensive patient under 30 — secondary cause workup mandated^[1]
Resistant hypertension (uncontrolled on 3 agents including a diuretic) — rule out secondary causes^[1]

First-line treatment

Interventions

Lifestyle modification^[1]
Sodium <2.3 g/day, DASH diet, 150 min/week moderate aerobic activity, weight reduction if BMI ≥25, alcohol ≤2 drinks/day men or ≤1 drink/day women

First-line drug therapy

Drug	Class	Adult	Paediatric	Notes
Amlodipine^[1]	Calcium channel blocker (DHP)	5–10 mg PO once daily	—	Preferred in elderly and isolated systolic hypertension
Telmisartan^[1]	Angiotensin receptor blocker (ARB)	40–80 mg PO once daily	2–6 mg/kg/day (max 40 mg)	Preferred with diabetic nephropathy and proteinuria
Hydrochlorothiazide^[1]	Thiazide diuretic	12.5–25 mg PO once daily	—	Often combined with ACE inhibitor or ARB

Amlodipine^[1]

Calcium channel blocker (DHP)

Adult: 5–10 mg PO once daily
Paediatric: —

Preferred in elderly and isolated systolic hypertension

Telmisartan^[1]

Angiotensin receptor blocker (ARB)

Adult: 40–80 mg PO once daily
Paediatric: 2–6 mg/kg/day (max 40 mg)

Preferred with diabetic nephropathy and proteinuria

Hydrochlorothiazide^[1]

Thiazide diuretic

Adult: 12.5–25 mg PO once daily
Paediatric: —

Often combined with ACE inhibitor or ARB

Safety-net

Take medication daily even when feeling well — most people with hypertension feel nothing^[1]
Sudden severe headache, chest pain, vision changes, or weakness on one side — call emergency services immediately^[1]
Avoid NSAIDs (ibuprofen, diclofenac) — they raise BP. Use paracetamol for pain instead^[1]

Referral criteria

BP ≥180/120 mmHg with chest pain, neurological deficit, dyspnoea, or AKIEmergency department, IV antihypertensive therapy^[1]
Resistant hypertension uncontrolled on 3 agents including a diureticCardiology or hypertension clinic^[1]
Age <30 with new hypertension OR abrupt onset OR hypokalaemia OR abdominal bruitEndocrinology and renal artery imaging^[1]
Pregnancy with BP ≥140/90Obstetric medicine^[2]

Clinical summary

Diagnosis, evaluation, and pharmacological management of essential hypertension in adults aged 18 and older.

References

1.2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults (2025)
2.Hypertension in pregnancy. ACOG (2024)
3.2024 ESC Guidelines for the management of elevated blood pressure and hypertension. European Heart Journal (2024)

Drug

Class

Adult

Paediatric

Notes

Amlodipine^[1]

Calcium channel blocker (DHP)

5–10 mg PO once daily

—

Preferred in elderly and isolated systolic hypertension

Telmisartan^[1]

Angiotensin receptor blocker (ARB)

40–80 mg PO once daily

2–6 mg/kg/day (max 40 mg)

Preferred with diabetic nephropathy and proteinuria

Hydrochlorothiazide^[1]

Thiazide diuretic

12.5–25 mg PO once daily

—

Often combined with ACE inhibitor or ARB

References

1.2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults (2025)

2.Hypertension in pregnancy. ACOG (2024)

3.2024 ESC Guidelines for the management of elevated blood pressure and hypertension. European Heart Journal (2024)