New guidance on how to manage high blood pressure recommends eliminating or substantially limiting alcohol (Photo by Joe Raedle/Getty Images)
The American Heart Association and nearly a dozen medical groups have released new guidance to prevent and manage high blood pressure, a leading cause of death in the U.S.
The 2025 guideline – published Thursday in American Heart Association’s peer-reviewed journals Circulation and Hypertension, and in JACC, the flagship journal of the American College of Cardiology – replaces the 2017 guidance.
The new guideline includes several changes since 2017, most notably the use of the American Heart Association’s risk calculator to estimate cardiovascular disease risk. It also provides new medication options, including the early treatment for high blood pressure to reduce the risk of cognitive decline and dementia; newer therapies like GLP-1 medications for some patients with high blood pressure and obesity, and recommendations for managing high blood pressure while pregnant.
What is considered high blood pressure?
By the numbers:
High blood pressure (including stage 1 or stage 2 hypertension) affects nearly half (46.7%) of all adults in the U.S., according to the American Heart Association. Hypertension is a leading cause of heart attacks and strokes. The blood pressure criteria remain the same as the 2017 guidelines:
- normal blood pressure is less than 120/80 mm Hg
- elevated blood pressure is 120-129/80 mm Hg
- stage 1 hypertension is 130-139 mm Hg or 80-89 mm Hg
- stage 2 hypertension is ≥140 mm Hg or ≥90 mm Hg.
How to prevent high blood pressure
What they're saying:
"High blood pressure is the most common and most modifiable risk factor for heart disease," chair of the guideline writing committee Dr. Daniel W. Jones, dean and professor emeritus of the University of Mississippi School of Medicine in Jackson, Mississippi. "By addressing individual risks earlier and offering more tailored strategies across the lifespan, the 2025 guideline aims to aid clinicians in helping more people manage their blood pressure and reduce the toll of heart disease, kidney disease, Type 2 diabetes and dementia."
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What you can do:
The guidance recommends the following lifestyle changes to prevent or manage high blood pressure:
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- limiting sodium intake to less than 2,300 mg per day, moving toward an ideal limit of 1,500 mg per day by checking food labels (most adults in the U.S. get their sodium from eating packaged and restaurant foods, not by adding salt to meals at home)
- Eliminating alcohol, or for those who choose to drink, consuming no more than two drinks per day for men and no more than one drink per day for women
- managing stress with exercise, as well as incorporating stress-reduction techniques like meditation, breathing control or yoga
- maintaining or achieving a healthy weight, with a goal of at least a 5% reduction in body weight in adults who have overweight or obesity
- following a heart healthy eating pattern, for example the DASH eating plan, which emphasizes reduced sodium intake and a diet high in vegetables, fruits, whole grains, legumes, nuts and seeds, and low-fat or nonfat dairy, and includes lean meats and poultry, fish and non-tropical oils
- increasing physical activity to at least 75-150 minutes each week including aerobic exercise (such as cardio) and/or resistance training (such as weight training)
- home blood pressure monitoring for patients to help confirm office diagnosis of high blood pressure and to monitor, track progress and tailor care as part of an integrated care plan.
New cardiovascular risk calculator
Dig deeper:
Developed by the American Heart Association in 2023, PREVENTTM is a tool to estimate 10- and 30-year risk of cardiovascular disease in people ages 30-79 years. It includes variables such as age, sex, blood pressure, cholesterol levels and other health indicators, including zip code as a measure for social drivers of health, the American Heart Association says.
It’s the first risk calculator that combines measures of cardiovascular, kidney and metabolic health to estimate cardiovascular risk.
"More precise risk estimates can help guide treatment decisions personalized for each individual," the AHA says.
High blood pressure linked to dementia, cognitive decline
Why you should care:
The links between high blood pressure and heart attack and stroke are widely known, but more recent research shows that blood pressure affects brain health, including cognitive function and dementia.
"High blood pressure can damage small blood vessels in the brain, which is linked to memory problems and long-term cognitive decline," the AHA says.
New medications for high blood pressure
The new guidance says more than one medication may be needed to lower blood pressure in some patients, particularly those with other conditions like Type 2 diabetes, obesity or kidney disease.
Blood pressure medications include:
- angiotensin-converting enzyme (ACE) inhibitors
- angiotensin II receptor blockers (ARBs)
- long-acting dihydropyridine calcium channel blockers
- thiazide-type diuretics
The guidance also suggests that newer medications like GLP-1s, which are commonly used for weight loss, may help some patients with high blood pressure and obesity.
The Source: This report includes information from the American Heart Association.