William Cornwell, Associate Professor of Cardiology
Nearly half of all Americans have high blood pressure – a condition called hypertension.
Hypertension is the No. 1 risk factor for heart disease and stroke. In addition, hypertension increases risk of dementia and cognitive decline. Heart disease, stroke, and dementia are the first-, fourth- and sixth-leading causes of death in the US.
Unfortunately, only 1 in 4 people with a history of high blood pressure have this condition under control.
In August 2025, the American Heart Association and the American College of Cardiology released new guidelines on prevention and management of hypertension, based on a comprehensive analysis of literature published over 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.
What are the primary takeaways of the new guidelines?
The most recent guidelines prior to this new statement were in 2017. Since that time, the medical community has learned a lot about hypertension and the best way to control it. The new guidelines provide a great deal of new information.
First, the definition of hypertension has changed. The criteria are more strict, and the target blood pressures are lower than in the past.
The criteria depend on the values of the “systolic” and the “diastolic” pressure. Systolic blood pressure, the top number, represents the pressure in the blood vessels when the heart is squeezing blood into the body.
Diastolic blood pressure, the bottom number, is the pressure in the blood vessels when the heart is relaxing. Both numbers are important when determining the severity of hypertension and how it is most appropriately managed.
The new guidelines have removed the category of “prehypertension,” which was defined by a systolic pressure of 120-139 millimeters of mercury (mm Hg), or a diastolic pressure of 80-99 mm Hg. Now, patients are categorized as having “elevated blood pressure” if their blood pressure is 120-129 over less than 80 mm Hg, or stage 1 hypertension if they are 130-139/80-89.
A reading of 140/90 or more is considered stage 2 hypertension, and a reading of 180/120 or greater is a hypertensive crisis. In essence, the bar has been lowered, and this change may impact millions of Americans.
People need to ask their doctors if they have hypertension based on these new criteria and whether or not they should be treated. It is also very important for patients to get advice from their doctors about lifestyle habits that they can incorporate into their daily routine, like diet, exercise, and healthy sleep habits to help lower blood pressure.
In addition, the guidelines encourage providers to use a risk calculator, called PREVENT – short for Predicting Risk of Cardiovascular Disease EVENTS – to determine a patient’s overall risk of cardiovascular disease and heart failure.
This tool represents a significant advance in personalizing medical care, since it incorporates risk factors unique to the individual, allowing for a tailored approach to medical care.
What is the link between alcohol intake and high blood pressure?
The guidelines encourage people to limit alcohol intake because alcohol increases blood pressure.
A 2023 meta-analysis of seven studies with nearly 20,000 people showed that systolic blood pressure will increase by about 1mmHg for every 10 grams of alcohol consumed.
A standard beer contains about 14 grams of alcohol, so regular alcohol consumption may increase blood pressure by several points over time. For people who have been drinking an excessive amount of alcohol but stop, their blood pressure may come back down.
That might not sound like much, but when combined with other unhealthy and risky behaviors, like sedentary behavior, excessive weight, inadequate sleep, psychological stress, and smoking, the risk factors start to add up quickly. Together, they can very quickly increase the risk of heart disease, stroke, and dementia.
The new guidelines encourage patients to reduce or eliminate alcohol consumption entirely compared with the old guidelines. For people who do want to drink alcohol, the new guidelines recommend that men should drink no more than two drinks per day, and women should drink no more than one drink per day.
What other lifestyle factors did the new report focus on?
The new guidelines also emphasize the fact that diet can have a major impact on blood pressure. They recommend that all adults – with or without hypertension – consume less than 2,300 milligrams of salt, or approximately 1 teaspoon, per day, and more ideally, less than 1,500 milligrams per day.
For a comparison, the average American eats more than 3,300 milligrams of salt per day. Patients may also consider potassium-based salt substitutes to further lower blood pressure.
The guidelines recommend a specific diet called the DASH diet, short for Dietary Approaches to Stop Hypertension, for patients with or without hypertension to prevent or treat elevated blood pressure. The DASH diet emphasizes fruits, vegetables, low-fat or nonfat dairy, and whole grains. This diet may lead to a reduction in blood pressure by up about 10 mm Hg.
The guidelines also emphasize the need to increase physical activity. On average, for every additional 30 minutes of aerobic exercise a person gets per week, systolic blood pressure decreases by 2 mm Hg and diastolic blood pressure drops by 1 mm Hg, with the largest reduction occurring at 150 minutes of dynamic exercise per week.
Regular exercise also helps you live longer and reduces the risk of cardiovascular disease, stroke, and dementia.
What are the main preventive strategies in the report?
The PREVENT risk calculator that the new guidelines recommend incorporates several factors, including demographics, cholesterol levels, medical history, and blood pressure, to determine risk. This risk calculator is free and available online to the general public.
The PREVENT calculator may be a helpful tool for all Americans since it reliably provides patients and providers with an assessment of overall risk assessment. But it is particularly helpful for people with multiple chronic conditions, like hypertension, high cholesterol, overweight/obesity, or diabetes.
The American Heart Association recommends eight essential health behaviors for controlling blood pressure and reducing risk of cardiovascular disease overall.
These include healthy diet, regular exercise, stopping or avoiding smoking, sleeping seven to nine hours per night, and controlling weight, cholesterol, blood sugar, and blood pressure.
Will the new guidelines change how doctors address high blood pressure?
One of the greatest advances with these new guidelines is the personalized approach to medical care through the use of the PREVENT calculator.
The guidelines recommend that doctors encourage their patients to check blood pressure at home to better understand the fluctuations in pressure that occur throughout the day.
Finally, the guidelines encourage physicians to be more aggressive about treating blood pressure. This may be an important change since uncontrolled blood pressure is a major risk factor for eventual development of heart disease and stroke.
William Cornwell, Associate Professor of Cardiology
It seems that we were already using what has become their guidelines.
Monitoring, recording blood pressure over time as after all, we ourselves are aging & changing.
I had an Aunt who went onto blood pressure control for high blood pressure about when she was in her 60’s.
In her 80’s she sort of went very “wonky” for about a year or so.
Lost her car licence in that part.
The cousins were able to push beyond the GP and actually got her to spend a week in hospital to fully monitor, taking off the high blood pressure pills, then figuriing she actually had low blood pressure, so other medicines were figured.
Lived independently for another decade, to receiving her birthday card from the Queen.
That guideline is complete bs designed to medicate more people.
Nearly everyone I know around sixties is on Blood Pressure pills.
Is it the guidelines suiting the drug companies because once your on that’s it.
Every month they are guaranteed a fortune.
I basically stopped drinking . ate less, keep exercising etc and not any difference to BP. Use my own monitor.
And statins.
Probably so Curious.
People have to figure how far to go on a necessary evil. 😎 to what works for them.
In part it can depend on the Doctor, does he listen to the patient, and is the information from a hypochondriac?
I just raised the story, seeing an experience & so noting how the body is not a constant, and age can change things as my Aunt told me when in her 80’s.
She had in her 60’s developed some thumping head aches, & that was what raised the concern about her blood pressure, obviously measured then so caused, raised some concern at that time.
Her brother had a very disabling stroke at the age of 30, though lived on smoking too, into his 80’s
What pleased her most, was that in the supposed treatment of her blood pressure, the head aches went away, and so she was able to continue her work, and stay active for a couple of decades..
Then for what ever reason her body reset, to a lower blood pressure.
Easy to figure in hind sight that she should have come off the treatment for high blood pressure much earlier, for a period of time, then to get something to fire her heart on for when her low blood pressure became a problem.
Funnily enough my grand mother for many years had low pressure, in her older years, & knew it when the heart boosting pill for the day, wore off.
She figured how to work & cope around that in her daily routine.
Today we can access much more info, guidelines, debates, discussions & forums with Dr, Google.
Part of the issue is the fear of heart attacks, by having a stressed out heart, not that an old person does not mind a “clean sweep”
The other part is the larger fear of a stroke, too much pressure in the brain, maybe an aneurism, some form of bleed.
So who wants a debilitating disabling stroke.
Then the other part is about the cardio vascular system, and clots.
So sometimes those on warfarin, or aspirin risk having a problem with bleeding.
In some ways has become much more up to us to figure some things for ourselves.
Do agree that Big Pharma is on a money making mission, by hook or by crook when they can.
However some parts are very good & useful medicines, like fire, a useful servant, a good tool, and can become a bad master.
I would agree with her , the tablets in the morning have changed my life , I had noticed over a period of 6 months that things were going a bit dodgy , took a year and a half to get the right tabs and dose , I monitor at home a couple of times a year so hopefully will see if my body goes back to the low pressure I had up till I turned 50.
There will always be some that may benefit. My point is that the protocol doesn’t account for aging, still bangs on about cholesterol, dairy etc.