The American Heart Association and American College of Cardiology released updated high blood pressure guidelines in August 2025, marking the first comprehensive revision since 2017. These new recommendations shift focus toward earlier intervention and personalized care to combat cardiovascular disease, which affects nearly half of all U.S. adults.
Key Changes and Recommendations
The 2025 guidelines maintain the same blood pressure classifications established in 2017: normal (<120/80 mm Hg), elevated (120-129/<80), stage 1 hypertension (130-139/80-89), and stage 2 (≥140/≥90). However, the approach to treatment has evolved significantly.
Lifestyle modifications remain the cornerstone of prevention and treatment. The guidelines recommend limiting sodium to under 2,300 mg daily (ideally 1,500 mg), maintaining healthy weight with at least 5% reduction for those with obesity, following heart-healthy eating patterns like DASH, and engaging in 75-150 minutes of weekly physical activity. Alcohol consumption should be limited to two drinks daily for men and one for women.
New Risk Assessment Tools
A major innovation is the mandatory use of the PREVENTTM risk calculator, developed by the American Heart Association in 2023. This tool estimates 10- and 30-year cardiovascular disease risk for people aged 30-79, incorporating traditional factors plus social determinants of health, including zip code data. This represents the first risk calculator combining cardiovascular, kidney, and metabolic health measures.
Brain Health Connection
The guidelines emphasize new research linking high blood pressure to cognitive decline and dementia. Early treatment targeting systolic pressure below 130 mm Hg is now recommended specifically to preserve brain health, as high blood pressure can damage small brain vessels linked to memory problems.
Pregnancy and Special Populations
Pregnancy-related recommendations have been strengthened, with closer monitoring before, during, and after pregnancy. Women with chronic hypertension should receive treatment when blood pressure reaches 140/90 mm Hg or higher during pregnancy. The guidelines also expand screening for primary aldosteronism and recommend considering newer GLP-1 medications for patients with both hypertension and obesity.
These comprehensive updates reflect growing understanding of hypertension’s wide-ranging health impacts and emphasize personalized, preventive approaches to reduce cardiovascular disease burden nationwide.