ConexiantGuideline Reclassifies 11% of Patients with Stage 1 Hypertension

A cross-sectional analysis in Annals of Internal Medicine finds the 2025 ACC/AHA hypertension guideline shift from age-based to risk-based treatment criteria would reclassify approximately 240,000 older Americans with Stage 1 hypertension as no longer automatically eligible for antihypertensive therapy. The reclassified group shares a consistent, lower-risk clinical profile.

Clinical Considerations

• All reclassified patients were female, nonsmokers, aged 65 to 68, with PREVENT risk scores averaging 7%, compared to 15% among patients retaining treatment eligibility.
• Among patients remaining eligible under the 2025 guideline, 57% qualified due to high-risk comorbidities and 43% based on a PREVENT score of 7.5% or higher.
• 99% of already-treated older adults had high-risk comorbidities or elevated PREVENT scores, suggesting the guideline change has minimal disruption to established treatment regimens.
• The reclassification affects only patients without diabetes, CKD, or clinical cardiovascular disease, limiting its scope to a narrow, healthier subgroup.

Practice Applications

• Calculate PREVENT 10-year CVD risk scores for all untreated adults aged 65 to 79 with Stage 1 hypertension before initiating pharmacotherapy.
• Defer antihypertensive medication in older female patients without comorbidities whose PREVENT scores fall below 7.5%.
• Reassure patients already on antihypertensives that the guideline change is unlikely to affect their treatment eligibility.
• Prioritize drug therapy for older patients with diabetes, CKD, or established cardiovascular disease regardless of PREVENT score.

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