Published: December 26, 2025
Hypertension management continues to evolve as new evidence reshapes diagnostic thresholds, treatment goals and therapeutic options. Now available as an on-demand continuing medical education presentation, “Hypertension 2025: What Is New – Updates in Diagnosis, Management and Renal Denervation,” given by Matthew J. Sousa, M.D., interventional cardiologist with Norton Heart & Vascular Institute, reviews key updates in hypertension guidelines, emphasizes cardiovascular risk–based treatment strategies, and explores the growing role of renal denervation for patients with resistant hypertension. The session provides practical guidance that clinicians can apply immediately in outpatient practice.
Hypertension remains one of the most common chronic conditions affecting Americans, with approximately 47% of the population living with high blood pressure. This translates to roughly 116 million people, though it is important to note that roughly 40% of these individuals have what is classified as Stage 1 hypertension. The implications extend far beyond simple blood pressure readings, as 40% of patients with hypertension also live with chronic kidney disease at various stages.
The most significant shift in recent guidelines involves how blood pressure levels are defined and categorized. The normal blood pressure range remains under 120/80, but elevated blood pressure is now defined as systolic readings between 120 and 129. Stage 1 hypertension encompasses readings from 130 to 139 systolic or 80 to 89 diastolic, while Stage 2 begins at 140/90.
These changes aren’t merely semantic. The treatment goals also have been updated, with the target now set at less than 130/80 for most patients. This represents a notable shift from previous recommendations and reflects accumulating evidence about the benefits of tighter blood pressure control.
Perhaps the most important evolution in hypertension management is the emphasis on comprehensive cardiovascular risk assessment rather than treating blood pressure in isolation. Normal or elevated blood pressure readings do not automatically trigger medication, but this is the biggest departure from previous approaches. The 2017 guidelines prioritize early intervention and classification by cardiovascular disease risk.
Stage 1 hypertension patients should be evaluated for diabetes and kidney disease, which are considered PREVENT (predicting risk of cardiovascular disease events) scores. The PREVENT score developed by the American Heart Association has emerged as an updated tool for cardiovascular risk assessment, building upon but requiring more data than the older Framingham Score or the ASCVD calculator. This comprehensive calculator incorporates nearly 12 variables including age, cholesterol levels, family history and other cardiovascular risk factors.
For patients with Stage 1 hypertension, treatment decisions hinge on cardiovascular risk stratification. Those with a 10-year cardiovascular disease risk of 10% or higher should begin pharmacotherapy immediately, alongside lifestyle modifications. Patients with lower risk profiles may focus initially on lifestyle interventions with close monitoring.
For Stage 2 hypertension, the approach is more straightforward: Most patients should begin both lifestyle modifications and pharmacologic treatment at diagnosis. The exception involves patients with significant barriers to medication adherence or those who strongly prefer attempting lifestyle modifications first, though this should be time-limited with clear follow-up parameters.
Resistant hypertension is defined as blood pressure that remains above goal (typically greater than 130/80 mmHg) despite concurrent use of three antihypertensive medications of different classes at optimal doses, ideally including a diuretic. Alternatively, patients requiring four or more medications to achieve blood pressure control are also classified as having resistant hypertension. This condition affects approximately 10% to 15% of patients with hypertension and represents a significant clinical challenge with substantially elevated cardiovascular risk.
Norton Heart & Vascular Institute is the only current Kentucky provider offering renal denervation. Use of the Symplicity Spyral system has provided relief of resistant hypertension to patients residing in Kentucky and Southern Indiana.
Ideal candidates for renal denervation include:
Patients should undergo thorough evaluation including:
When considering renal denervation for patients with resistant hypertension, clinicians should:
Ongoing research is exploring:
Renal denervation represents an important addition to the treatment arsenal for resistant hypertension, offering a device-based option for patients whose blood pressure remains uncontrolled despite optimal medical therapy. As the technology continues to evolve and evidence accumulates, it is poised to play an increasingly important role in comprehensive hypertension management.