Nearly half of all adults in the U.S. have high blood pressure—defined as 130/80 mm Hg or higher—and it remains the top preventable risk factor for heart attack, stroke, heart failure, kidney disease, and dementia.
A new joint guideline from the American Heart Association and the American College of Cardiology, endorsed by 11 other medical organizations, lays out updated recommendations to help reduce this burden and improve outcomes.
The 2025 guideline stresses early treatment through both lifestyle changes and medications when needed, recommends proactive management of blood pressure during pregnancy, and introduces a new tool called the PREVENT™ risk calculator to guide personalized care.
These guidelines are published in Circulation, Hypertension, and the Journal of the American College of Cardiology (JACC).
The guideline emphasizes lifestyle changes as the first step for all adults.
This includes limiting sodium intake to under 2,300 mg per day (ideally 1,500 mg), reducing alcohol, exercising regularly, managing stress through techniques like meditation or yoga, and following a heart-healthy diet like the DASH eating plan.
Maintaining a healthy weight and monitoring blood pressure at home are also key strategies.
Blood pressure categories remain the same as the 2017 guideline:
– Normal: less than 120/80 mm Hg
– Elevated: 120–129/<80 mm Hg
– Stage 1 hypertension: 130–139/80–89 mm Hg
– Stage 2 hypertension: 140/90 mm Hg or higher
The guideline recommends clinicians use the PREVENT™ calculator, which factors in a person’s age, sex, blood pressure, cholesterol levels, and even zip code to estimate the 10- and 30-year risk of heart disease. This helps tailor treatment to individual needs.
New recommendations also include lab tests for kidney health (urine albumin-to-creatinine ratio) for all patients with high blood pressure, and expanded screening for primary aldosteronism, a condition that can contribute to high blood pressure.
One of the most notable updates is the connection between high blood pressure and brain health. Research confirms that elevated blood pressure can damage brain vessels and lead to memory problems and dementia.
The new guideline recommends early treatment to keep systolic blood pressure (top number) below 130 mm Hg to help preserve cognitive function.
When medications are needed, preferred options include ACE inhibitors, ARBs, calcium channel blockers, and thiazide-type diuretics.
For people with stage 2 hypertension (≥140/90), treatment should begin with two medications, ideally in one combination pill. GLP-1 medications may be considered in patients with obesity and high blood pressure.
For pregnant women, the guideline recommends treating chronic hypertension when systolic pressure reaches 140 mm Hg or higher, and considering low-dose aspirin to reduce the risk of preeclampsia.
Continued monitoring after childbirth is crucial, as high blood pressure can persist and increase the risk of long-term complications.
Dr. Daniel Jones, chair of the guideline writing committee, emphasized that this update aims to support all clinicians and empower patients with actionable tools to manage their blood pressure and protect their heart and brain health.
The 2025 guideline was developed by a panel of volunteer experts and endorsed by major health organizations including the American Medical Association, the Association of Black Cardiologists, and the National Medical Association, among others. It replaces the 2017 guideline and will be updated as new evidence emerges.
If you care about blood pressure, please read studies about common blood pressure medication that may extend your healthy life span and common high blood pressure drug linked to sudden cardiac arrest.
For more about blood pressure, please read studies that timing matters when taking high blood pressure pills and 1 in 5 people with high blood pressure taking a drug worsen the disease.
The study is published in Hypertension.
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