MANAGEMENT OF SYSTEMIC ARTERIAL HYPERTENSION IN PRIMARY HEALTH CARE: A CRITICAL AND ANALYTICAL NARRATIVE REVIEW BASED ON THE 2025 BRAZILIAN HYPERTENSION GUIDELINE
Abstract
Study type: narrative literature review. Background and objectives: Systemic arterial hypertension (SAH) is the leading modifiable cardiovascular risk factor and one of the greatest challenges in Brazilian public health, with an estimated prevalence of 36% among adults and a blood pressure control rate of only 33%. The Brazilian Hypertension Guideline 2025 (DBHA 2025) introduces paradigm-shifting changes requiring a critical synthesis oriented toward primary health care (PHC) practice. Method: Narrative review with systematic search in PubMed/MEDLINE, LILACS, SciELO, and Cochrane Library (2014–2025). The DBHA 2025 serves as the central normative reference, contrasted with ACC/AHA 2017 and ESC/ESH 2018/2023 guidelines. Main findings: The DBHA 2025 establishes a universal BP target of <130/80 mmHg; recommends dual-combination therapy as the preferred initial pharmacological treatment; formally adopts the pre-hypertension category (BP 120–139/80–89 mmHg); incorporates the PREVENT score for cardiovascular risk stratification; and includes iSGLT2, GLP-1a, and finerenone in specific cardiorenal contexts. Conclusion: Implementing DBHA 2025 recommendations in PHC requires ongoing professional training, expanded access to fixed-dose combinations and ambulatory BP monitoring, and strengthened multidisciplinary approaches. Future research should evaluate implementation strategies in socially vulnerable contexts and indigenous, quilombola, and rural SUS populations.
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