New guidelines from the American Heart Association and the American College of Cardiology call for a more aggressive approach to managing high blood pressure and recommend abstaining from alcohol.
The organizations, which continuously review the latest research to guide medical providers, have issued their first comprehensive update since 2017. Controlling blood pressure is a critical, modifiable risk factor for heart disease—the world’s leading cause of death—and can also reduce the risk of kidney disease, type 2 diabetes, and dementia.
While the target numbers for adults remain unchanged, the strategy for treatment has shifted. Normal blood pressure is still considered less than 120/80 mm Hg, and elevated blood pressure is 120-129 systolic over less than 80 diastolic. However, for readings of 130/80 mm Hg or higher, medical providers are now urged to recommend intervention.
Blood pressure is measured with a systolic reading (the top number), which indicates the force of blood pumping from the heart, and a diastolic reading (the bottom number), which measures pressure as the heart rests between beats. High blood pressure typically has no symptoms but forces the heart and blood vessels to work harder, eventually damaging arteries and increasing the risk of a heart attack or stroke.
Under the new guidelines, if a patient’s systolic pressure is between 130 and 139, providers should first recommend healthy lifestyle changes. Medication is only advised if blood pressure does not decrease within three to six months. This marks a change from the 2017 recommendation to prescribe both lifestyle changes and medication for anyone with a systolic pressure above 140.
“We are trying to more aggressively control blood pressure to prevent cardiovascular disease, strokes, kidney disease, and we now know lowering blood pressure also helps reduce the risk for dementia,” said Dr. Daniel Jones, chair of the guidelines writing committee.
Recommended lifestyle changes include achieving a healthy weight, adopting a heart-healthy diet, reducing salt intake, managing stress, and getting at least 150 minutes of moderate physical activity plus resistance exercise weekly.
In a significant departure from previous advice, the new guidelines also recommend forgoing alcohol. Past recommendations suggested that if people chose to drink, they should limit intake to one drink or less per day for women and two or less for men. Jones noted that a growing body of evidence shows alcohol’s negative impact on blood pressure. “We put forward the ideal as abstinence,” he stated, “and for those who choose to drink, less is better.”
The guidelines also place a new emphasis on the importance of blood pressure monitoring for individuals who are pregnant or planning to become pregnant, as hypertension can pose risks both during and long after pregnancy.
Dietary advice continues to endorse the DASH (Dietary Approaches to Stop Hypertension) diet, which is rich in fruits, vegetables, whole grains, and lean proteins, while being low in fat and sugar. The guidelines stress limiting sodium intake to less than 2,300 mg per day, with an ideal target of 1,500 mg, and suggest using potassium-enriched salt substitutes.
For individuals with overweight or obesity, a weight loss of at least 5% is recommended. The guidelines also support clinically proven interventions such as weight-loss medications, including GLP-1s, and bariatric surgery for severe cases.
Jones acknowledged the difficulty of making these changes but stressed their effectiveness. “The first line of things we recommend for both prevention and treatment of high blood pressure have to do with eating and exercise,” he said. “We live in a very difficult environment for food… but the good news is that all that stuff works if you’re willing to do it.”
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