A new high blood pressure guideline just published emphasizes prevention and early treatment to reduce cardiovascular disease risk.
The new clinical guideline was published in August 2025 in the American Heart Association’s peer-reviewed journals, Circulation and Hypertension and in JACC, the flagship journal of the American College of Cardiology.
The new guideline reflects several major changes since 2017, including use of the American Heart Association’s PREVENTTM (Predicting Risk of cardiovascular disease EVENTs) risk calculator to estimate cardiovascular disease risk.
It also provides updated guidance on medication options, including the early treatment for high blood pressure to reduce the risk of cognitive decline and dementia; use of specific medications including the possible addition of newer therapies such as GLP-1 medications for some patients with high blood pressure and overweight or obesity, and recommendations for managing high blood pressure before, during and after pregnancy.
Importance of controlling high blood pressure
High blood pressure (including stage 1 or stage 2 hypertension) affects nearly half (46.7%) of all adults in the U.S., is the leading cause of death in the U.S. and around the world. The blood pressure criteria remain the same as the 2017 guideline:
- normal blood pressure is less than 120/80 mm Hg;
- elevated blood pressure is 120-129 mm Hg and <80 mm Hg;
- stage 1 hypertension is 130-139 mm Hg or 80-89 mm Hg; and
- stage 2 hypertension is ≥140 mm Hg or ≥90 mm Hg.
Importance of a healthy lifestyle
The new guideline reaffirms the critical role healthy lifestyle behaviors play in preventing and managing high blood pressure, and it encourages health care professionals to work with patients to set realistic, achievable goals.
Healthy behaviors such as those in Life’s Essential 8, the American Heart Association’s metrics for heart health, remain the first line of care for all adults.
Preventing and managing high blood pressure with healthy lifestyle behaviors, such as following a heart-healthy diet including reducing salt intake, staying physically active, maintaining a healthy weight and managing stress — combined with early treatment with medication to lower blood pressure if necessary — are recommended to reduce the risk of heart attack, stroke, heart failure, kidney disease, cognitive decline and dementia,
Specific blood pressure-related guidance includes:
- 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 the salt shaker);
- Ideally, consuming no 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); and
- Home blood pressure monitoring is recommended 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.
Addressing each of these lifestyle factors is especially important for people with high blood pressure and other major risk factors for cardiovascular disease because it may prevent, delay or treat elevated or high blood pressure.
The focus of today’s column was to provide an overview of the new 2025 joint guideline from the American Heart Association and the American College of Cardiology. The emphasis should focus on lifestyle factors for controlling one’s blood pressure to the extent possible.
References/additional resource information
Information which includes use of the American Heart Association’s PREVENT (Predicting Risk of cardiovascular disease EVENTS) risk calculator to estimate cardiovascular disease risk is available in the review article published in the journal Circulation and two additional sources at mdcalc.com; professional.heart.org; jwatch.org.
Check out the American Heart Association’s (AHA) Essential 8 for cardiovascular health at heart.org.
Mark A. Mahoney, Ph.D. has been a Registered Dietitian/Nutritionist for over 40 years and completed graduate studies in Nutrition & Public Health at Columbia University. He can be reached at marqos69@hotmail.com.
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