Barbell Medicine Podcast Episode #369: The 2025 Blood Pressure Update
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Oct 7, 2025 
In this discussion, physician Austin Baraki, an expert in kidney and cardiovascular physiology, explores crucial changes in hypertension management. He details the shift from strict blood pressure cutoffs to a risk-based approach, emphasizing the new 2025 ACC/AHA guidelines aiming for lower systolic targets. Baraki highlights the importance of screening for the often-overlooked primary aldosteronism and supports using low-dose combination therapy for better outcomes. He also evaluates the new Apple Watch feature for hypertension detection and its clinical implications.
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Risk Is A Continuous Spectrum
- Cardiovascular risk behaves as a continuous spectrum rather than a binary state determined by a single cutoff.
- Shifting to a risk-based approach better matches treatment intensity to lifetime risk and individual factors.
Treat BP Based On Absolute Risk
- Using a pooled risk calculator (like PREVENT) helps decide how aggressively to treat blood pressure.
- Treat based on absolute cardiovascular risk rather than isolated BP numbers alone.
Target Lower BP When Safe
- Aim for office BP <130/80 and consider lowering systolic toward <120 mmHg when safe.
- Individualize targets and confirm out-of-office readings before aggressive lowering.