Interpretation of the 2025 AHA/ACC hypertension guidelines: new perspectives on hypertension prevention and management
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摘要: 高血压作为全球心血管疾病的首要危险因素，全球患病规模持续扩大且年轻化趋势明显，已成为重大公共卫生挑战。其防治策略的科学优化，对显著降低脑卒中、冠心病及慢性肾脏病的发病与死亡负担至关重要。2025年8月，美国心脏协会(American Heart Association，AHA)联合美国心脏病学会(American College of Cardiology，ACC)发布了自2017年以来首次重大更新的成人高血压预防、检测、评估及管理指南。此次更新立足近年循证医学新证据，回应全球高血压流行趋势下的临床新需求。本文系统梳理该指南的核心更新内容，从高血压定义与分类、风险分层工具、治疗启动时机、药物选择策略及血压控制目标5个维度，对比其与2017版指南的关键差异，并结合循证证据解析更新逻辑。同时，针对全科医疗场景，提出兼具科学性与可操作性的指南应用建议，为临床医生精准应用指南、实现高血压个体化管理提供实用参考，助力进一步提升高血压防治成效。Abstract: Hypertension, the leading risk factor for cardiovascular diseases worldwide, has shown a continuously expanding prevalence and a distinct younger trend, emerging as a major public health challenge. Scientific optimization of its prevention and treatment strategies is crucial for significantly reducing the morbidity and mortality burdens of stroke, coronary heart disease, and chronic kidney disease. In August 2025, the American Heart Association (AHA) and the American College of Cardiology (ACC) jointly released the first major update to the guidelines for the prevention, detection, evaluation, and management of high blood pressure in adults since 2017. This update is based on new evidence from recent evidence-based medicine and addresses the emerging clinical needs amid the global hypertension epidemic. This article systematically summarizes the core updated content of the guideline, compares the key differences between this version and the 2017 edition from five dimensions-hypertension definition and classification, risk stratification tools, timing of treatment initiation, pharmacological selection strategies, and blood pressure control targets-and interprets the rationale behind the updates in light of evidence-based data. Additionally, targeting general practice settings, it proposes scientific and operable recommendations for guideline application, providing practical references for clinicians to accurately implement the guideline and achieve individualized hypertension management, thereby facilitating the further improvement of hypertension prevention and treatment outcomes.
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Key words:
- Hypertension /
- General practice /
- AHA hypertension guidelines /
- Preventive medicine
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表 1 2025 AHA/ACC指南高血压定义与分类
Table 1. Definition and classification of hypertension in the 2025 AHA/ACC guidelines
血压分类 血压 正常 收缩压＜120 mmHg且舒张压＜80 mmHg 血压升高 收缩压120~129 mmHg且舒张压＜80 mmHg 高血压1级 收缩压130~139 mmHg或舒张压80~89 mmHg 高血压2级 收缩压≥140 mmHg或舒张压≥90 mmHg 
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表 2 PREVENT评分风险分层标准及临床干预建议
Table 2. Risk and clinical recommendations for the PREVENT score
风险等级 10年CVD风险 临床干预建议 低危 ＜5.0% 血压≥130/80 mmHg时，优先启动3~6个月生活方式干预，暂不推荐药物治疗 中危 5.0%~ < 7.5% 结合个体风险增强因素综合决策，可通过冠状动脉钙化评分进一步细化评估，再确定是否启动药物治疗 高危 ≥7.5% 血压≥130/80 mmHg即推荐启动降压药物治疗，同时联合生活方式干预强化防控
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表 3 2025 AHA/ACC指南治疗启动时机推荐
Table 3. 2025 AHA/ACC guidelines on timing of treatment initiation recommendations
血压水平 低危(PREVENT < 5.0%) 中危(PREVENT 5.0%~ < 7.5%) 高危(PREVENT≥7.5%) 血压升高(120~129/ < 80 mmHg) 生活方式干预 强化生活方式干预 生活方式干预+考虑药物治疗(合并CKD/糖尿病者) 1级高血压(130~139/80~89 mmHg) 生活方式干预，每6个月复查 强化生活方式干预，每3个月复查，持续升高则用药 立即启动药物治疗 2级高血压(≥140/90 mmHg) 立即启动双药联合治疗 立即启动双药联合治疗 立即启动三药联合治疗
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表 4 2025 AHA/ACC指南不同人群血压控制目标
Table 4. Blood pressure control targets in the 2025 AHA/ACC guidelines
人群类别 收缩压目标(mmHg) 舒张压目标(mmHg) 一般成人(< 65岁) < 130 < 80 老年患者(65~79岁) < 130 < 80 老年患者(≥80岁) < 130(衰弱者 < 140) < 80(衰弱者 < 90) 合并糖尿病 < 130 < 80 合并CKD(eGFR>30 mL/min) < 130 < 80 合并CKD(eGFR≤30 mL/min) < 140 < 90 合并脑卒中(急性期后) < 130 < 80 合并冠心病 < 130 < 80
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