GUIDELINE ALERT – 2025 Hypertension Guidelines

The brand new 2025 Hypertension Canada guidelines have landed! And…buckle up for some big changes:

·       New diagnostic criteria

·       Fewer cutoffs to remember

·       Starting with more medication

More patients will likely be diagnosed, and our approach to medication is changing fundamentally.

Who Are These Guidelines For? (And Who They're NOT For)

These guidelines are for primary care providers and are ultra concise, skipping the nuance of more complicated BP management. As well, they apply only to:

·       adults in a primary care setting.

Importantly, these guidelines do not apply to:

·       Pediatric patients

·       Pregnant patients

The Key Points

1. Universal, Lower Diagnostic Cutoff: Gone are the days of different diagnostic cutoffs for patients with diabetes or kidney disease. It's a single, simplified threshold: 130/80 mmHg.

2. Different Medication Start Cutoff: Start lifestyle + two medications if BP is over 140 systolic…EXCEPT if they have a high cardiovascular risk* (including over 74 yrs of age), then start at 130 systolic.

3. Monotherapy is OUT for Initial Treatment: For most patients starting pharmacotherapy, the recommendation is to begin with TWO medications (ideally in a single combination pill… and yes the generic form of these is cheaper than the separate pills).

4. Universal Treatment Target: The primary systolic target is <130 mmHg for everyone, provided treatment is well-tolerated. Notably, there's no specific diastolic target mentioned in the treatment recommendations.

*High cardiovascular risk:

- Known CVD (e.g. cardiovascular disease, heart failure, peripheral artery disease, cerebrovascular disease)

- DM1 or DM2

- CKD

- Framingham risk score ≥ 20%

- Age ≥ 75 yrs

Sources:

CMAJ Article

Algorithm: Treatment

Algorithm: Diagnosis