New Blood Pressure Guidelines Mean You Could Now Have Hypertension

Nearly half of people in the United States live with high blood pressure, a condition known as hypertension.

Hypertension is the number one risk factor for heart disease and stroke. It also raises the likelihood of dementia and cognitive decline. Heart disease, stroke and dementia are the first-, fourth- and sixth-leading causes of death in the US.

Despite this, just 1 in 4 people with a history of high blood pressure have it adequately controlled.

In August 2025, the American Heart Association and the American College of Cardiology published updated guidance on preventing and managing hypertension, drawing on a wide-ranging review of research from the past 10 years.

The Conversation US asked cardiologist Dr William Cornwell of the University of Colorado Anschutz Medical Campus to explain what the new guidelines mean, and how you can work with your doctor to manage your blood pressure.

Hypertension guidelines: what are the primary takeaways of the new guidelines?

Before this update, the most recent guidelines were issued in 2017. Since then, clinicians and researchers have learned substantially more about hypertension and the most effective ways to bring it under control, and the new guidance reflects that with a large amount of fresh detail.

A key change is that the definition of hypertension has been revised. The thresholds are tighter, and the blood pressure targets are lower than they were previously.

These thresholds are based on two readings: the "systolic" and the "diastolic" pressure. Systolic blood pressure (the upper number) reflects the pressure in the blood vessels as the heart contracts to push blood around the body.

Diastolic blood pressure (the lower number) is the pressure in the blood vessels while the heart relaxes. Both figures matter when assessing how severe hypertension is, and what approach to management is most appropriate.

The updated guidelines have also removed the "prehypertension" category, which used to refer to a systolic pressure of 120-139 millimetres of mercury (mm Hg), or a diastolic pressure of 80-99 mm Hg.

Instead, people are now classed as having "elevated blood pressure" when their reading is 120-129 over less than 80 mm Hg, or as having stage 1 hypertension when it is 130-139/80-89.

A measurement of 140/90 or higher is defined as stage 2 hypertension, while 180/120 or above is considered a hypertensive crisis. Put simply, the threshold has been lowered, and this revision could affect millions of Americans.

People should ask their doctors whether they meet the new criteria for hypertension and whether treatment is recommended.

It is equally important that patients seek guidance from their doctors on day-to-day lifestyle measures that can help reduce blood pressure, such as changes to diet, exercise, and improving sleep habits.

The guidelines also advise clinicians to use a risk calculator called PREVENT - short for Predicting Risk of Cardiovascular Disease EVENTS - to estimate an individual’s overall risk of cardiovascular disease and heart failure.

This is a major step forwards in personalised care because it draws on risk factors specific to each person, supporting a more tailored plan for medical management.

What is the link between alcohol intake and high blood pressure?

The guidelines advise limiting alcohol because drinking alcohol raises blood pressure.

A 2023 meta-analysis of seven studies involving nearly 20,000 people found that systolic blood pressure increases by about 1mmHg for every 10 grams of alcohol consumed.

A standard beer contains about 14 grams of alcohol, so drinking regularly can nudge blood pressure up by several points over time. For people who have been drinking excessive amounts and then stop, blood pressure may fall back down.

On its own, that may not seem like a large change. However, alongside other unhealthy and high-risk behaviours - including sedentary behaviour, excessive weight, inadequate sleep, psychological stress and smoking - these risks can accumulate rapidly.

Taken together, they can quickly increase the chances of heart disease, stroke and dementia.

Compared with older guidance, the new guidelines place greater emphasis on cutting down alcohol or stopping altogether.

For those who do choose to drink, the updated recommendation is that men should have no more than two drinks per day, and women should have no more than one drink per day.

Which other lifestyle factors did the new report focus on?

The new guidelines also underline how strongly diet can influence blood pressure. They advise all adults - whether or not they have hypertension - to keep salt intake below 2,300 milligrams per day (roughly 1 teaspoon), and ideally below 1,500 milligrams per day.

For context, the average American consumes more than 3,300 milligrams of salt each day. People may also consider potassium-based salt substitutes as another way to help lower blood pressure.

The report endorses a specific eating plan known as the DASH diet - short for Dietary Approaches to Stop Hypertension - for preventing or treating elevated blood pressure in people with or without hypertension.

The DASH diet prioritises fruit, vegetables, low-fat or nonfat dairy products, and whole grains. Following it can reduce blood pressure by up about 10 mm Hg.

The guidelines also highlight the importance of increasing physical activity.

On average, each additional 30 minutes of aerobic exercise per week is associated with a 2 mm Hg drop in systolic blood pressure and a 1 mm Hg fall in diastolic blood pressure, with the biggest reduction seen at 150 minutes of dynamic exercise per week.

Exercising regularly is also linked to a longer life and a lower risk of cardiovascular disease, stroke and dementia.

What are the main preventive strategies in the report?

The PREVENT risk calculator recommended by the guidelines uses multiple inputs - including demographics, cholesterol levels, medical history and blood pressure - to estimate risk. It is free to use and accessible online to the public.

PREVENT can be useful for all Americans because it provides patients and clinicians with a dependable overall risk assessment. It may be especially valuable for those living with several long-term conditions, such as hypertension, high cholesterol, overweight/obesity or diabetes.

The American Heart Association identifies eight essential health behaviours to help control blood pressure and reduce cardiovascular disease risk overall.

These are: eating a healthy diet, exercising regularly, stopping or avoiding smoking, sleeping seven to nine hours per night, and managing weight, cholesterol, blood sugar and blood pressure.

Will the new guidelines change how doctors address high blood pressure?

One of the most significant developments in these guidelines is the move towards personalised care, supported by the PREVENT calculator.

The guidance recommends that doctors encourage patients to monitor their blood pressure at home, helping to capture how readings can vary over the course of a day.

Lastly, the guidelines urge clinicians to treat blood pressure more assertively. This could be an important shift, because uncontrolled blood pressure is a major risk factor for the later development of heart disease and stroke.

William Cornwell, Associate Professor of Cardiology, University of Colorado Anschutz Medical Campus

This article is republished from The Conversation under a Creative Commons licence. Read the original article.

An earlier version of this article was published in September 2025.