The American Heart Association (AHA) and American College of Cardiology (ACC), together with numerous other professional societies, have issued new guidance on hypertension, updating the widely referenced 2017 recommendations. The full document spans 105 pages and provides a thorough review of evidence and best practices.

Below are a few selected highlights — both positive takeaways and ongoing concerns.

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Things I Like

1. Accurate Measurement of Blood Pressure
The authors devote significant attention to the importance of accurate blood pressure (BP) measurement. They include a clear illustration of a patient properly positioned — sitting upright, feet flat on the floor, with the arm supported at heart level on a table. Alongside the picture is an eight-point checklist that outlines the essential steps of correct BP measurement.

This emphasis is long overdue. Despite decades of research confirming that inaccurate readings lead to under- or over-treatment, proper technique remains shockingly rare in everyday practice. In my 30 years of clinical experience, I don’t think I have ever witnessed BP being measured precisely according to recommended standards — not once. Somehow, the culture of medicine has evolved in a way that accepts shortcuts and inaccuracies as normal.

We have implemented time-outs before surgery, sepsis bundles, and numerous other quality measures, but when it comes to something as fundamental as a vital sign, mediocrity has been codified as standard. It is remarkable that such a simple intervention could meaningfully improve quality of care almost overnight. For this reason, I applaud the authors for spotlighting proper technique and reinforcing that accurate BP measurement is not optional — it is central to good hypertension management.

2. Home-Based BP Monitoring
Another strong point of the updated guidance is its recognition of the value of out-of-office BP monitoring. Home measurements are often more reliable than in-office readings, given the prevalence of “white coat hypertension” and the inconsistent practices seen in clinics. Encouraging patients to check their BP at home, with validated devices and proper technique, empowers them to be active participants in their care while giving clinicians more accurate data on which to base treatment decisions.

The new document underscores that home monitoring can help with early diagnosis, monitoring treatment effectiveness, and engaging patients in long-term lifestyle changes. When combined with proper education on device use and recording methods, this approach can significantly improve outcomes and reduce unnecessary medication adjustments.