New, evidence-based hypertension clinical practice guidelines reflect the ‘front edge of medicine’

The Department of Defense and Department of Veterans Affairs’ Clinical Practice Guidelines for Diagnosis and Management of Hypertension in Primary Care, updated in September 2026, bring the latest evidence into high-quality patient care and warfighter medical readiness.

The updated CPG replaces the 2020 version and provides a comprehensive framework for managing a condition affecting 13% of active duty service members, including new guidance on incorporating Glucagon-like peptide-1 receptor agonists into treatment of individuals with hypertension and co-occurring obesity. Commonly known as GLP-1, these medications are a type of drug that mimics a hormone in the body which helps to lower blood sugar and support weight loss, according to the Centers for Disease Control and Prevention.

The revised guidelines advance Defense Health Agency Director Navy Vice Adm. Darin K. Via’s charge “to be on the front edge of medicine,” aligning with his Lines of Effort to reinforce DHA’s commitment as a combat support agency through access to joint, integrated clinical standards of care, skills sustainment for military medicine professionals, and timely,first-rate care to patients.

New tools for managing hypertension

Hypertension means high blood pressure, the CPG states, and is diagnosed when a systolic blood pressure is greater than or equal to 130 millimeters of mercury, or mmHg — the measure of the pressure in your arteries when your heart beats. If left untreated, high blood pressure can result in strokes, heart attacks, kidney disease, heart failure and early death.

One of the most significant changes in the new guidelines is a strong recommendation for the use of GLP-1 medications for weight management in patients who have hypertension, known more commonly as high blood pressure, and are overweight or obese. The guidelines also recommend a combination of a healthy low-sodium diet and physical activity greater than 120 minutes a week to improve blood pressure control.

“The guidelines have always contained recommendations for weight loss, but weight loss is hard to achieve and very hard to maintain,” said Navy Capt. (Dr.) Mark Tschanz, U.S. Second Fleet command surgeon, internal medicine specialist, and member of the CPG working group. “This time we found strong evidence that GLP-1 medications do help patients achieve weight loss and a significant reduction in blood pressure.”

Army Capt. (Dr.) Patricia Vu, a leadership and faculty development fellow at Madigan Army Medical Center and member of the CPG working group, said the recommendation gives clinicians more options to tailor hypertension treatment plans.

“The new guideline expands the provider’s toolkit … enabling more options for individualized care,” she said.

Growing evidence lowers blood pressure treatment targets

The updated guidelines also strongly recommend treating many patients with hypertension to a systolic blood pressure below 130 mmHg.

Tschanz noted “landmark” research informing this recommendation, including data from the Systolic Blood Pressure Intervention Trial, finding more intensive blood pressure treatment reduced major cardiovascular events.

“The goal of blood pressure control is to prevent further disease and disability for a higher quality of life,” Vu said. “We now have more data that demonstrates that treatment to a systolic blood pressure below 130 mmHg gets us closer to that goal.”

Updated guidelines strengthen warfighter readiness

For the military population, the impact of the new guidelines extends beyond controlling a number on a blood pressure cuff.

Tschanz said warfighter medical readiness and deployability were considered “from step one” as the working group developed the guidelines. Hypertension, he said, should not automatically become a deployment-limiting condition, but it must be diagnosed and managed promptly.

The guideline also considers military populations with unique treatment requirements, including aviators who may have restrictions on medications they are allowed to take. Tschanz said evidence-based treatment options in the guidelines give providers greater flexibility to control hypertension while minimizing unnecessary duty limitations.

Unifying, integrated care for past, present, and future beneficiaries

The availability of joint DOD/VA CPG standards gives clinicians across both health systems access to the same evidence-based recommendations to support DHA’s emphasis on providing the global healthcare enterprise beneficiaries deserve, according to Vu.

The common standard, she said, supports a clinically proficient medical force while helping all beneficiaries receive consistent, high-quality care.

“The updates help providers and other members of DOD/VA healthcare teams stay on top of the evidence, so the care provided is based on data that supports the best outcomes and not on anecdotal, observational, or out-of-date practices,” she added.

Staying on the front edge

Tschanz said evaluating emerging treatments while continuing to test established practices against the latest evidence is central to staying on the front edge of medicine.

That work also demonstrates the broader role CPG update work groups play in advancing DHA’s mission and lines of effort by turning an evolving body of medical research into actionable guidance providers can use across the enterprise.

“CPG work groups do the heavy lifting of combing through the current literature for evidence to make recommendations that enable providers to deliver the most up-to-date care that keeps service members healthy and fit for duty,” Vu said.

Vu and Tschanz agree guidelines like those contained in the most recent hypertension treatment update keep medical warriors at the forefront of clinical practice and help the DHA deliver high-quality care, protect warfighter readiness, and strengthen medical capabilities that support the joint force.

“Continually evaluating new evidence and treatments is incredibly important to staying on the front edge of medicine and ensuring we’re optimizing care for our beneficiaries,” Tschanz said. “This guideline update does exactly that.”

CPG and resources

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