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Nearly half of American adults have high blood pressure, the leading cause of heart disease and stroke and a significant risk factor for other health conditions such as kidney disease, cognitive decline, dementia, vision problems, and pregnancy complications.
While this statistic is alarming, there is good news: We have more research than ever to help people lower their blood pressure to a healthy level or prevent them from getting high blood pressure in the first place.
In August 2025, the American Heart Association (AHA) and the American College of Cardiology (ACC) released new guidelines for the prevention, detection, and treatment of high blood pressure, also called hypertension. I served on a writing committee for these guidelines, which were also developed with and endorsed by 11 other health care organizations.
The UT Southwestern Medical Center Comprehensive Heart and Vascular Center has followed several of these best practices for many years, and we are educating providers to implement these recommendations. Our physicians and researchers lead and contribute to some of the most profound studies that shaped the new guidelines, including the Dallas Heart Study – a 25-year population-based study that has driven groundbreaking findings in high blood pressure, heart disease, and heart failure prevention and care.
The last hypertension guidelines were released in 2017, and much has changed in our understanding of the disease and how best to manage it. Here are some of the top takeaways from the new guidelines that you should know to improve your heart health.
High blood pressure occurs when the force of your blood pushing against the walls of your blood vessels is too high. We measure blood pressure in millimeters of mercury, or mm Hg. You’ve probably heard blood pressure given as one number over another number, such as 120 over 80. The first number is systolic pressure, and the second number is diastolic pressure.
What changed: The 2017 AHA/ACC guidelines recommended starting treatment for high blood pressure when the patient’s reading is above 140 mm Hg systolic. The new guidelines lower that starting point to 130 mm Hg, which means recommending treatment sooner to help prevent cardiovascular damage.
The 2025 guidelines maintain the ranges for what is considered normal blood pressure and hypertension:
Normal blood pressure: Less than 120/80 mm Hg
Elevated blood pressure: 120-129 mm Hg and <80 mm Hg
Stage 1 hypertension: 130-139 mm Hg or 80-89 mm Hg
Stage 2 hypertension: ≥140 mm Hg or ≥90 mm Hg
Why it matters: Since 2017, multiple clinical trials such as STEP and ESPRIT have reinforced the benefits of lowering a person’s blood pressure, including reducing the number of adverse heart events and death. These studies provide a much stronger reason to reduce systolic blood pressure below 130 mm Hg and when possible below 120 mm Hg. In addition, the SPRINT MIND1 study and China Rural Hypertension Control Project2 (CRHCP) showed benefits of lowered blood pressure in preventing cognitive decline and dementia.
Primary aldosteronism is a condition in which the adrenal glands produce too much of a hormone that regulates blood pressure and electrolyte balance. It’s estimated that up to 25% of people with high blood pressure have primary aldosteronism but few people with hypertension are screened for the disease.
What changed: The new guidelines recommend that patients who have resistant hypertension – which persists despite treatment with three or more medications – should be screened for primary aldosteronism. Patients do not need to stop their blood pressure medications to be screened.
Why it matters: Between 8.5% and 20% of U.S. adults with hypertension have a resistant form, so this is a significant change in screening recommendations. We hope these new guidelines will help better identify people with primary aldosteronism and connect them with more effective treatment.
What changed: The new guidelines also recommend testing the ratio of urine albumin and creatinine in all patients with high blood pressure. In the 2017 guidelines, this test was considered optional.
Albumin is a type of protein that should be found mostly in the blood and in trace amounts in urine. Creatinine is a type of chemical waste produced when muscle tissue is broken down. Having a high urine albumin-creatinine ratio (uACR) can be a sign of kidney problems, which are common with chronic, uncontrolled hypertension.
Why it matters: A normal uACR is lower than 30 mg/g. Higher readings can be a sign of kidney disease. Knowing your uACR can better guide your care team in finding an effective hypertension medication. It will also point us toward care to halt and treat possible kidney damage.
What changed: For the first time, the guidelines recommend minimizing – and ideally avoiding – alcohol consumption. If you choose to drink, the guidelines advise no more than two drinks per day for men and no more than one drink per day for women to help prevent and treat hypertension. A drink is considered to be equal to:
12 ounces of beer (5% alcohol)
8 ounces of malt liquor (7% alcohol)
5 ounces of wine (12% alcohol)
1.5 ounces of liquor, 80 proof
Why it matters: Even small amounts of alcohol raise blood pressure. Excessive drinking also can cause heart rhythm problems such as atrial fibrillation, changes in heart muscle size and function, and brain dysfunction. Drinking too much can lead to stroke or heart attack, and chronic alcohol consumption has been linked to several types of cancer, including liver cancer and colorectal cancer.
Recent clinical trials such as the BPROAD trial3 increasingly have shown the importance of reducing blood pressure in people with diabetes and chronic kidney disease (CKD).
What changed: The 2025 guidelines recommend starting patients with diabetes or CKD on medication immediately after their systolic blood pressure rises above 130 mm Hg – and without first seeing whether lifestyle modifications can reduce blood pressure. The goal is to get these patients to a normal blood pressure as quickly as possible.
Why it matters: People with diabetes or kidney disease are already at increased risk of heart attack, heart failure, and stroke. Controlling blood pressure sooner – before it becomes severely elevated – can reduce the risk of cardiovascular death for these patients.
If you have high blood pressure, taking your readings regularly at home can be an important part of managing the disease.
What changed: The 2025 guidelines recommend that all patients who are willing should monitor their blood pressure at home. All health care providers should consider at-home readings in the patient’s average blood pressure levels when making diagnoses and recommending medications.
Why it matters: Some people deal with “white coat syndrome,” in which their blood pressure always reads higher at the doctor’s office. This can be due to stress about the appointment, walking to the clinic, or a range of other factors. Getting good, reliable, regular readings at home provides your doctor with a better look at your day-to-day blood pressure. Multiple readings should be used to diagnose high blood pressure.
Here are some tips for taking accurate home blood pressure readings:
Use a validated blood pressure monitoring device: Fewer than 20% of blood pressure devices on the market are validated by the American Medical Association. Smartwatches and cuffless devices do not yet provide accurate blood pressure measurements. Check whether your device is validated.
Use good techniques:
Don’t smoke, drink caffeine, or exercise within 30 minutes of taking your blood pressure. Rest at least five minutes before taking the reading.
Measure at the same time every day.
Support your arm on a flat surface at heart level; sit with both feet flat on the floor.
Be still while measuring: No talking, texting, or scrolling.
Take two readings one minute apart and record the results to share with your doctor.
Communicate: Discuss your home readings with your doctor to understand the steps you can take to improve or maintain your blood pressure.
Having high blood pressure during pregnancy (preeclampsia) can increase a woman’s risk of heart problems in the future. The new recommendations emphasize earlier and tighter management of blood pressure to prevent serious complications with the pregnancy or the patient’s health.
What changed: Updates recommend that women get treatment with specific medications when their systolic blood pressure is 140 mm Hg or higher and/or if their diastolic blood pressure is 90 mm Hg or higher.
Why it matters: High blood pressure can influence a woman’s health before, during, and after pregnancy. Attending postpartum doctor appointments is key to detecting and managing high blood pressure after pregnancy and reducing the risk of hypertension-related kidney and cardiovascular problems, including stroke.
Women who have high blood pressure and want to become pregnant should talk with their doctor about whether taking low-dose aspirin could help reduce the risk of developing preeclampsia. Work with an Ob/Gyn who understands the health implications of high blood pressure in pregnancy and effective strategies to manage it before, during, and after delivery.
Anyone can develop high blood pressure. And research indicates people are getting it at younger ages. This shows prevention is key, and one of the best options is to make heart-healthy lifestyle changes, including updates to your nutrition, exercise, and medications.
What changed: The 2025 guidelines suggest people who use salt in food preparation and flavoring at home could benefit from potassium-based substitutes. Patients with kidney disease and those on medications that reduce the body’s ability to process potassium should not use potassium-based salt substitutes.
Why it matters: Making small changes can help incrementally reduce your blood pressure and improve your overall health. Proven strategies include:
Take medication as prescribed: Hypertension drugs may not make you feel different when you take them, but they work behind the scenes to normalize your blood pressure.
Reduce sodium intake: Processed foods – such as packaged items and fast food – tend to be high in sodium.
Move every day: Get at least 30 minutes of activity daily, such as walking, gardening, or swimming.
Manage stress: Make time to rest and relax at least a few minutes each day. Mindfulness practices such as meditation or practicing yoga can help reduce stress and focus your mind.
Achieve a healthy weight: Talk with your doctor about a healthy weight target based on your age, mobility, and overall health.
Making positive changes can feel daunting, but you don’t have to manage the journey alone. Lean on your health care team – the doctors, nurses, pharmacists, dietitians, and specialists – to help you make an achievable, sustainable plan. Together, this team will assess your needs and help get you the medications and resources you need to improve your health.
These new blood pressure guidelines won’t change things overnight. It takes time to educate health care professionals and patients about changes. I’m optimistic that people will use the new guidelines to help them get ahead of the curve when it comes to their heart health.
About UT Southwestern Medical Center
UT Southwestern, one of the nation’s premier academic medical centers, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty members have received six Nobel Prizes and include 24 members of the National Academy of Sciences, 23 members of the National Academy of Medicine, and 13 Howard Hughes Medical Institute Investigators. The full-time faculty of more than 3,200 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide care in more than 80 specialties to more than 140,000 hospitalized patients, more than 360,000 emergency room cases, and oversee nearly 5.1 million outpatient visits a year.
