High blood pressure remains one of the most common and dangerous health problems worldwide, affecting nearly half of all U.S. adults and contributing to heart disease, stroke, kidney disease, and even dementia.
Now, a new set of clinical guidelines offers updated advice on how to prevent, detect, and treat high blood pressure more effectively—and earlier.
The 2025 guideline, released by the American Heart Association and partner organizations, replaces the 2017 version and adds new tools, treatment strategies, and recommendations based on the latest research.
The aim is to help more people achieve healthy blood pressure and reduce their lifetime risk of serious illness.
One major addition is the use of the American Heart Association’s PREVENT risk calculator.
This tool estimates a person’s 10- and 30-year risk for cardiovascular disease by considering factors like age, sex, blood pressure, cholesterol, kidney function, and even zip code to account for social and environmental influences on health.
By understanding their long-term risk, patients and doctors can make more personalized decisions about when to start treatment.
The guideline continues to define normal blood pressure as under 120/80 mm Hg, with stage 1 hypertension beginning at 130/80 and stage 2 at 140/90 or higher.
However, it now places even more emphasis on prevention and early intervention.
Lifestyle changes—such as reducing salt intake, staying active, maintaining a healthy weight, managing stress, limiting alcohol, and eating a heart-healthy diet—remain the first line of defense for everyone.
These behaviors are part of the American Heart Association’s “Life’s Essential 8” for cardiovascular health.
When lifestyle changes aren’t enough, early medication can help prevent not only heart attacks and strokes but also cognitive decline.
Research now shows that high blood pressure damages small blood vessels in the brain, increasing the risk of dementia. The updated advice recommends aiming for a systolic blood pressure (top number) below 130 mm Hg in adults with hypertension to protect brain health.
Treatment options have also expanded. In addition to standard medications like ACE inhibitors, ARBs, calcium channel blockers, and diuretics, some people with high blood pressure and obesity may benefit from newer drugs such as GLP-1 medications. For those with more severe hypertension, starting with two medications—ideally in a single pill—remains recommended.
The guideline also addresses specific needs for pregnant women. High blood pressure during pregnancy can have serious consequences, including preeclampsia and premature delivery.
The updated advice suggests starting treatment earlier in pregnancy for women with chronic hypertension and considering low-dose aspirin to reduce complications. Postpartum monitoring is stressed as well, since blood pressure problems can begin or persist after delivery.
Importantly, the guideline encourages doctors to check kidney function more often in people with high blood pressure and to screen more patients for certain hormone-related causes of hypertension, such as primary aldosteronism.
Dr. Daniel W. Jones, chair of the guideline writing committee, summed up the goal: “Prevention, early detection, and management of high blood pressure are critical to long-term heart and brain health, which means longer, healthier lives.”
With more precise risk assessment tools, tailored treatments, and a strong focus on healthy habits, the new recommendations aim to help people take control of their blood pressure before it causes lasting harm.
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