New Blood Pressure Guidelines Put Prevention First

The American Heart Association (AHA) and American College of Cardiology (ACC), along with several partner organizations, have released new 2025 guidelines for managing high blood pressure. These recommendations replace the 2017 standards and emphasize prevention, early intervention, and a personalized approach to care.

Why These Guidelines Matter

Nearly half of U.S. adults live with high blood pressure (≥130/80 mm Hg). It is the most common preventable risk factor for cardiovascular disease, which includes heart attacks, strokes, heart failure, and kidney disease. Research now shows it also plays a critical role in brain health, with untreated hypertension linked to cognitive decline and dementia.

Key Updates in the 2025 Guideline

• Early Treatment: Lifestyle changes remain the foundation of care, but earlier use of medication is encouraged to prevent complications.
• Brain Health: Blood pressure control is now recommended to help reduce risks of memory loss and dementia.
• Pregnancy Care: Special attention is placed on managing blood pressure before, during, and after pregnancy to reduce risks for both mother and child.
• Risk Calculator: Clinicians are urged to use the PREVENT™ tool, developed in 2023, to estimate 10- and 30-year cardiovascular risk. This calculator incorporates factors such as age, blood pressure, cholesterol, and social determinants of health.

Lifestyle Recommendations

The new guideline reinforces practical strategies that reduce risk:

• Reduce sodium to under 2,300 mg daily, ideally below 1,500 mg
• Limit alcohol (up to two drinks per day for men, one for women)
• Follow a heart-healthy diet like DASH, rich in fruits, vegetables, whole grains, and lean proteins
• Maintain a healthy weight, aiming for at least a 5% reduction if overweight
• Stay physically active with 75–150 minutes of exercise weekly
• Manage stress through mindfulness, breathing exercises, or yoga
• Monitor blood pressure at home to track progress

Updated Testing and Treatment Approaches

Two new laboratory recommendations are included:

• Routine urine albumin-to-creatinine testing for kidney health
• Expanded screening for primary aldosteronism, a hormonal condition that raises blood pressure

When medication is needed, the guideline advises starting with common drug classes such as ACE inhibitors, ARBs, calcium channel blockers, or thiazide diuretics. For patients with stage 2 hypertension (≥140/90 mm Hg), treatment with two medications—ideally combined into one pill—is recommended. In some cases, newer therapies like GLP-1 drugs may be added, especially for those with obesity.

High Blood Pressure and Pregnancy

The guideline provides detailed recommendations for managing hypertension during pregnancy. Tighter blood pressure control is now advised, with treatment beginning when readings reach 140/90 mm Hg or higher. Low-dose aspirin may also help reduce the risk of preeclampsia. Postpartum care is emphasized, as blood pressure issues can appear or persist after delivery.

The Bigger Picture

“High blood pressure is the most common and most modifiable risk factor for heart disease,” said Dr. Daniel W. Jones, chair of the guideline writing committee. “By addressing individual risks earlier and offering tailored strategies across the lifespan, these guidelines aim to reduce the toll of heart disease, kidney disease, Type 2 diabetes, and dementia.”

The 2025 guideline provides clinicians with updated tools and patients with practical steps to protect heart and brain health. Prevention and early management are at the core of this new approach.