A new 2025 guideline from leading U.S. heart and blood pressure organizations updates how adults should prevent, detect, evaluate and manage high blood pressure. Built on the latest scientific evidence, the guideline emphasizes a combination of healthy lifestyle, earlier intervention with medications when needed, and personalized care to reduce the risks of heart attack, stroke, kidney disease, cognitive decline and dementia.
What’s new in the 2025 guideline
– Expanded use of the PREVENT risk calculator: Clinicians are advised to estimate a patient’s 10- and 30-year risk of cardiovascular events using the American Heart Association’s PREVENT tool. This calculator, launched in 2023, integrates traditional risk factors with health indicators including blood pressure, cholesterol, age and even social determinants of health via ZIP code to tailor treatment plans.
– Broader screening tests: All patients with high blood pressure should receive a urine albumin-to-creatinine ratio test to assess kidney health. The guideline also expands screening for primary aldosteronism by widening the use of the aldosterone-to-renin ratio, including people with obstructive sleep apnea, and suggests considering this screening in adults with stage 2 hypertension to improve detection and targeted treatment.
– Stronger focus on brain health: Evidence linking blood pressure to cognitive function and dementia has prompted an emphasis on treating high blood pressure earlier, with an SBP target of less than 130 mm Hg for many adults to help protect brain health.
– New or expanded treatment options: Medication strategies emphasize using a combination approach when needed. For some patients—especially those with type 2 diabetes, obesity or kidney disease—two medications may be started at once, ideally in a single combination pill, if blood pressure is 140/90 mm Hg or higher. The guideline also notes the potential use of newer therapies, including GLP-1 medications, for certain patients with high blood pressure and overweight or obesity.
– Guidance for pregnancy and postpartum care: For pregnant people, the guideline provides recommendations on when to treat high blood pressure and highlights the use of low-dose aspirin (81 mg/day) to reduce the risk of preeclampsia in those planning pregnancy or who are pregnant. Postpartum blood pressure monitoring remains important to prevent complications and to support long-term cardiovascular health.
Key lifestyle guidance aligned with the new guideline
Healthy lifestyle remains the foundation of blood pressure management and is paired with personalized medical care. The guideline reiterates and strengthens advice in several areas:
– Sodium intake: Aim for less than 2,300 mg per day, with a target toward 1,500 mg per day when possible, by reading food labels and prioritizing fresh foods.
– Alcohol: If consumed, limit to no more than two drinks per day for men and one per day for women.
– Stress management: Combine regular exercise with stress-reduction techniques such as mindfulness, deep breathing or yoga.
– Weight management: Strive for meaningful weight loss, with goals of at least a 5% reduction in body weight for those with overweight or obesity.
– Heart-healthy eating pattern: Emphasize the DASH plan—rich in vegetables, fruits, whole grains, lean proteins and healthy fats, with reduced sodium.
– Physical activity: Target 75–150 minutes of aerobic activity per week, plus resistance training as able.
– Home blood pressure monitoring: Use at-home readings to confirm office measurements and track progress as part of an integrated care plan.
What the guideline means for patients and clinicians
– Earlier, more personalized action: By using PREVENT and updated risk assessment, clinicians can tailor when to start therapy and which combination of treatments to use, potentially preventing heart and brain-related complications years down the line.
– More comprehensive evaluation: Routine kidney screening becomes a standard part of evaluation, improving detection of conditions that contribute to high blood pressure and enabling targeted treatment.
– A broader toolset for hypertension management: The guideline accommodates individual health profiles, including the possible addition of newer medications in certain scenarios and prioritizes combination therapy for higher blood pressure readings.
– A focus on cognitive and brain health: By tying tighter blood pressure control to better long-term brain health, the guideline reinforces the importance of managing blood pressure not just to prevent heart disease, but also to preserve memory and other cognitive functions.
Practical takeaways for readers
– If you have high blood pressure, expect your clinician to discuss a personalized plan that may include lifestyle changes, medication or both, with a goal of moving toward or achieving blood pressure under 130/80 mm Hg.
– Be prepared to discuss your daily habits, including salt intake, weight management, activity level and stress management, as these factors remain central to effective control.
– You may be asked to complete urine and hormone tests (such as the albumin-to-creatinine ratio and the aldosterone-to-renin ratio) to better understand the source of your hypertension and to guide treatment.
– For pregnant individuals or those planning pregnancy, expect specific guidance on safe medications and the potential use of aspirin to reduce preeclampsia risk, along with careful postpartum follow-up.
Overall, the 2025 guideline reinforces a proactive, evidence-based approach to high blood pressure that blends lifestyle optimization, precise risk assessment and a flexible, stepped pharmacologic strategy. By addressing cardiovascular risk early and considering brain health, the guideline aims to help more people live longer, healthier lives.
Notes for potential readers
– If you’re living with high blood pressure or have risk factors, schedule a discussion with your healthcare provider to review your risk and the appropriateness of home monitoring, lab tests and treatment strategies under the new guidelines.
– Staying active, watching sodium intake, maintaining a healthy weight and following a heart-healthy eating pattern remain practical, actionable steps you can start now to support your overall cardiovascular health.