Beyond the 2025 guidelines: tailoring hypertension management to the underlying pathogenic pathway in the age of precision medicine

Purpose of review Hypertension is the most common chronic disease in developed countries, with a prevalence exceeding 25–30% of adults. The updated hypertension guidelines define evidence-based blood pressure targets and provide clinicians with a framework for achieving them. Examining the underlying hypertension phenotypes provides a complementary approach to the management of hypertension. Recent findings Rather than a one-size fits all approach, a more directed hypertension management involves tailoring therapy toward the predominant pathophysiologic mechanism or “Phenotype” responsible for blood pressure elevation, rather than adhering to a uniform, stepwise treatment algorithm. Such an approach allows clinicians to tailor therapy to the key biological drivers of hypertension in the individual patient. It is important to note that these pathways overlap and are not isolated, while oftentimes, one single phenotype is the predominant over the others. This article examines these distinct phenotypes, outlining their key characteristics and the best therapeutic approaches for each. Summary Our ability to delineate hypertension phenotypes through biomedical, genetic and clinical testing is advancing rapidly, and precision medicine innovations are reshaping hypertension care with a level of specific and clinical insights that were not previously attainable, paving the way for the refinement of future hypertension guidelines.