The American College of Cardiology (ACC) has released a new Expert Consensus Decision Pathway (ECDP) published in JACC, designed to bridge the gap between hypertension guidelines and the realities of clinical practice. While the 2025 ACC/AHA hypertension guidelines set the evidence-based foundation, this new document is built for the trenches—offering step-by-step guidance for clinicians managing patients whose blood pressure just won't budge.

The ECDP is organized around five core questions, covering accurate BP measurement (in-office and at home), diagnosing true resistant hypertension using the RESIST framework, stepwise treatment escalation, team-based care structures, and the role of emerging technologies like wearables and remote monitoring.

Key Takeaways:

• The RESIST acronym guides diagnosis: rule out pseudoresistance, exclude interfering substances, support lifestyle changes, intensify medications, screen for secondary causes, and transfer to specialists if needed
• Renal denervation is positioned as a device-based option when lifestyle and drug therapies fall short
• Cuffless BP devices are not endorsed for clinical use until proper validation is established
• CPT codes for out-of-office BP management are included to support reimbursement

Why it matters: Resistant hypertension is notoriously difficult to manage, and uncontrolled BP dramatically raises the risk of heart attack, stroke, and kidney disease. This practical toolkit gives care teams—from nurses to cardiologists—a clearer, more actionable playbook.