A new set of 2025 guidelines for managing high blood pressure emphasizes early detection, personalized treatment, and lifestyle changes to protect heart and brain health.
The recommendations come from top U.S. medical organizations. These updated guidelines replace those from 2017 and reflect the latest research on how to prevent and manage hypertension more effectively.
Nearly half of U.S. adults—about 46.7%—have high blood pressure, making it the leading cause of death both in the U.S. and worldwide. The new guidance keeps the same blood pressure categories: normal is under 120/80 mm Hg, elevated is 120–129/80 mm Hg, stage 1 hypertension is 130–139 or 80–89 mm Hg, and stage 2 is 140/90 mm Hg or higher.
The guidelines focus on preventing heart attack, stroke, kidney disease, cognitive decline, and dementia by promoting healthy lifestyle habits.
These include eating a heart-healthy diet with less salt, exercising regularly, maintaining a healthy weight, reducing stress, and avoiding excessive alcohol. Medication is still recommended for people whose blood pressure remains high despite these changes.
Key lifestyle suggestions include reducing sodium to under 2,300 mg per day (ideally 1,500 mg), cutting back on alcohol (no more than two drinks per day for men, one for women), using stress-relief methods like exercise, yoga, or deep breathing, and aiming for at least 75–150 minutes of physical activity per week.
People are also encouraged to monitor their blood pressure at home to track progress and adjust treatment.
A major update is the use of a new risk calculator, called PREVENT, which estimates a person’s risk for heart disease, stroke, or heart failure over 10 to 30 years. It considers factors such as blood pressure, cholesterol, age, sex, and social conditions like where a person lives. This helps doctors better tailor care to each patient.
The guideline also includes changes to lab testing. For all people with high blood pressure, a urine test measuring the albumin-to-creatinine ratio is now recommended to check kidney health.
Another test, the plasma aldosterone-to-renin ratio, is also recommended more broadly to screen for a condition called primary aldosteronism—especially in people with sleep apnea or stage 2 hypertension.
Importantly, the guideline highlights the link between high blood pressure and brain health. Studies show that high blood pressure can damage small blood vessels in the brain, raising the risk of memory loss and dementia. The guideline recommends treating people early to keep systolic pressure below 130 mm Hg to help protect the brain.
For people with diabetes, obesity, or kidney disease, more than one blood pressure medicine may be needed. Doctors are advised to start with common types like ACE inhibitors, ARBs, calcium channel blockers, or thiazide-type diuretics.
If one drug isn’t enough, another can be added—often in a single combination pill. The guideline also mentions newer options like GLP-1 drugs for those who are overweight.
For pregnant women, the new guideline recommends treating chronic high blood pressure if it reaches 140/90 mm Hg or more. Low-dose aspirin may also be helpful to lower the risk of preeclampsia.
Postpartum care is vital as high blood pressure can develop or continue after giving birth. The guideline encourages ongoing monitoring and annual checks for those who had pregnancy-related hypertension.
In summary, the 2025 high blood pressure guideline supports early, personalized, and lifelong strategies to lower blood pressure. It encourages lifestyle changes first, followed by medications when needed, and aims to help more people live longer, healthier lives by preventing serious diseases linked to high blood pressure.
The study is published in Hypertension.
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