The American Heart Association's New High Blood Pressure Guidelines, Explained

High blood pressure affects nearly half of people in the United States, yet only about 1 in 4 have it under control, according to the U.S. Centers for Disease Control and Prevention (CDC). What's troubling is that high blood pressure usually doesn't cause symptoms, which is why it's often called the "silent killer." If it's not managed, high blood pressure can raise the risk of heart attack, stroke, kidney disease, and even dementia (per Mayo Clinic).

To help people get ahead of the problem, the American Heart Association (AHA) released new guidelines in a 2025 review in Hypertension. The update to the 2017 guidelines introduces a new hypertension risk calculator called PREVENT (Predicting Risk of cardiovascular disease EVENTs) that lowers the threshold for treatment. Since pregnancy can raise blood pressure, the guidelines also recommend keeping a closer eye on possible hypertension before, during, and after pregnancy.

Managing blood pressure isn't always about medication. The guidelines stress that lifestyle changes such as eating a heart-healthy diet, staying active, reducing sodium, and managing stress are the first line of defense in controlling blood pressure without medication. But they also highlight newer treatments that have benefits beyond lowering blood pressure, such as protecting kidney function and reducing the risk of dementia. GLP-1 agonists not only treat type 2 diabetes and obesity but also modestly lower blood pressure and cardiovascular risk.

The guidelines didn't change the ranges for what's considered high blood pressure. Normal blood pressure is still defined as below 120/80 millimeters of mercury (mmHg), and stage 1 hypertension remains 130–139 mmHg systolic or 80–89 mmHg diastolic. The treatment goal is still to lower blood pressure to under 130/80 mmHg, a target that has not changed since the 2017 guideline.

An important factor in managing high blood pressure is knowing a patient's 10-year risk of cardiovascular disease. In the past, treatment was recommended if the risk of heart attack or stroke was 10% or higher, based on an older calculator. The newer PREVENT tool provides a broader picture. It includes risk for heart failure, incorporates kidney function, and even considers neighborhood-level social factors. 

(Read about 14 things you didn't realize were hurting your heart.)

According to the new guideline, risk assessment should begin at age 30. If your PREVENT risk is 7.5% or higher and your blood pressure is 130/80 mmHg or above, your doctor will recommend both lifestyle changes and medication. If your risk is below 7.5% but your blood pressure is elevated or in the hypertensive range, lifestyle changes come first. If, after three to six months, your blood pressure remains elevated, medication is then recommended.