Understanding the 2025 Blood Pressure Guidelines

The American Heart Association (AHA) and the American College of Cardiology (ACC) have released the first major update to blood pressure guidelines since 2017. High blood pressure—also called hypertension—often has no symptoms, yet it can quietly damage blood vessels and increase the risk of heart disease, stroke, kidney problems, and other vascular complications over time.

This article breaks down what’s new in the 2025 blood pressure guidelines, how to interpret your numbers, and what these updates mean for your care.

Hypertension Highlights: What’s New in the 2025 Blood Pressure Guidelines

The 2025 AHA and ACC hypertension guidelines introduce several important updates that affect how high blood pressure is diagnosed, monitored, and treated. Here’s what to know:

Care Is Now Based on Overall Cardiovascular Risk

The 2025 update introduces a new tool called the PREVENT™ calculator.
This replaces older risk models and estimates your chances of heart disease, stroke, kidney disease, or heart failure using modern data.

Why it matters:

PREVENT uses information from more than 3 million people collected between 1992 and 2022, making it far more accurate than earlier calculators that relied on data from the 1960s–1990s. It also removes race as a factor, improving fairness and accuracy.

What this means for you:

Your clinician will consider your full health profile, not just your blood pressure number. PREVENT looks at your age, cholesterol, blood sugar, kidney health, and even ZIP code to estimate your overall risk. If your risk is high, medication may be recommended sooner. If it’s low, your care plan may focus on lifestyle changes first.

Accurate Blood Pressure Measurement Is Essential

Getting an accurate blood pressure reading—both in the office and at home—is now emphasized as a top priority. Even small mistakes, like using the wrong cuff size or skipping rest before the test, can raise readings by 5 to 10 points.

Why it matters:

Accurate readings help detect hidden problems such as white coat hypertension (higher readings in the office) and masked hypertension (normal in the office but high at home).

What this means for you:

Your clinician may ask you to track your blood pressure at home to confirm a diagnosis and guide your treatment plan.

When Blood Pressure Treatment Should Begin

In the past, clinicians usually waited until blood pressure reached 140/90 mmHg before prescribing medication. The 2025 AHA/ACC blood pressure guidelines now suggest that people at higher cardiovascular risk—based on the PREVENT™ calculator—may benefit from starting treatment earlier, around 130/80 mmHg.

Why it matters:

High blood pressure can quietly harm your heart, kidneys, and blood vessels long before you feel any symptoms. Starting medication sooner can help prevent complications like heart attack, stroke, or kidney disease.

What this means for you:

If your clinician recommends starting blood pressure medicine earlier than before, it’s because your overall risk—not just your number—matters most. Medication works best when combined with heart-healthy habits such as regular exercise, limiting salt, and following the DASH diet.

Managing Blood Pressure Helps Protect Your Brain

The 2025 blood pressure guidelines highlight a stronger link between hypertension and brain health. Keeping your blood pressure within a healthy range may help lower the risk of cognitive decline and dementia later in life.

Why it matters:

High blood pressure can damage the brain’s small blood vessels over time, reducing blood flow and increasing the risk of vascular dementia. According to the AHA and ACC, lowering blood pressure in adults with hypertension may help reduce the risk of cognitive decline and dementia.

What this means for you:

Managing blood pressure isn’t just about heart health—it can also support long-term brain health. For most adults, the goal is to keep blood pressure below 130/80 mmHg, unless your clinician recommends otherwise.

Lifestyle Changes Are Still the Foundation of Blood Pressure Control

If your blood pressure is slightly above normal (starting at 120/80 mmHg), your clinician may recommend starting with lifestyle changes before prescribing medication. These steps can make a meaningful difference in keeping your blood pressure within a healthy range.

Effective ways to lower blood pressure through lifestyle changes include:

• Following the DASH diet: Focus on fruits, vegetables, lean proteins, and whole grains.

• Reducing salt (sodium) intake: Aim for less than 1,500–2,300 milligrams (mg) per day.

• Staying active: Regular physical activity, such as brisk walking, helps lower blood pressure and supports heart health.

• Maintaining a healthy weight: Even small weight loss can help reduce strain on your arteries.

• Limiting alcohol and avoiding tobacco: Both can raise blood pressure over time.

Why it matters:

Lifestyle habits are the first step in managing blood pressure and improving long-term health. They also support heart, brain, and kidney function.

What this means for you:

Clinicians often suggest trying lifestyle changes for 3 to 6 months before starting medicine, unless your overall risk is high. These habits can reduce blood pressure by 2 to 11 mmHg, depending on the changes you make. Even if medication becomes necessary later, staying active and eating well can help your treatment work more effectively.

Expanded Testing for Kidney and Hormone Health

If you have high blood pressure, your clinician may now recommend additional tests to uncover hidden causes or complications.
One key test is the urine albumin-creatinine ratio (ACR), which checks how well your kidneys are working. Kidney disease can both cause and worsen high blood pressure.

Clinicians may also test for hormone-related conditions, such as primary hyperaldosteronism, where the body makes too much of a hormone that raises blood pressure.

Blood Pressure and Pregnancy

The new guidelines emphasize safer options for managing high blood pressure during pregnancy. Some medications are considered safer than others, and low-dose aspirin may be recommended in certain cases to help lower the risk of preeclampsia—a serious pregnancy complication involving high blood pressure.

If you’re pregnant or planning to become pregnant, talk with your clinician before making any medication changes.

Newer Medication Options

Alongside traditional blood pressure medicines, newer treatments are also being explored.
The guidelines note that GLP-1 receptor agonists, which are often used to treat obesity or type 2 diabetes, may also help lower blood pressure in some people.

Your clinician can help determine whether these medications are appropriate as part of your overall treatment plan.

Know Your Blood Pressure Numbers

Your blood pressure reading includes two numbers—systolic (the top number) and diastolic (the bottom number). Both are measured in millimeters of mercury (mmHg) and together show how hard your heart is working to pump blood through your arteries.

Here’s how to understand your blood pressure levels:

Tip: “Systolic” shows the pressure when your heart beats. “Diastolic” shows the pressure when your heart rests between beats.

How to Measure Blood Pressure Correctly at Home

Home blood pressure checks give the most accurate picture of how your heart is working day to day. An American Heart Association study found that only 1 in 7 online images show the correct way to measure blood pressure. Knowing the right technique helps ensure your readings are accurate and reliable.

Before You Measure

To get an accurate reading, prepare your body and environment first:

• Avoid caffeine, exercise, or smoking for at least 30 minutes before measuring.

• Empty your bladder.

• Sit in a quiet, comfortable room.

• Rest for 5 minutes before starting.

During the Reading

When you’re ready to check your blood pressure:

• Sit with your feet flat on the floor and your back supported.

• Keep your arm supported at heart level.

• Use the correct cuff size and a validated device (one tested for accuracy).

• Take two readings, 1 minute apart, and record the average.

• Stay still and don’t talk or use your phone.

• Keep a log or use your monitor’s app to track your results and share them with your clinician.

Check if Your Monitor Is Validated

Before relying on your home device, make sure it’s accurate. You can look up your monitor on ValidateBP.org to confirm that it has been tested and approved for accuracy.If you don’t have a monitor, ask your clinician about reliable options. Some insurance plans may help cover the cost.

Getting an Accurate Blood Pressure Reading at Your Visit

The 2025 blood pressure guidelines emphasize that readings taken in your clinician’s office should follow the same careful steps used at home. If your blood pressure isn’t measured correctly—such as if your arm isn’t supported or you’re not given time to rest—it can affect your results.

If that happens, it’s okay to speak up or ask for a brief pause before your reading. You might say:

• “Would you mind if I sit quietly for a few minutes before you take my blood pressure?”

• “Can we make sure my arm is supported at heart level? That’s how I check it at home.”

Taking a moment to ensure proper technique helps you and your care team get the most accurate results.

The Bottom Line

The 2025 AHA and ACC blood pressure guidelines show that managing blood pressure is about more than a single number.
Care now focuses on your overall health risk, accurate readings, and the right balance of lifestyle changes and medication when needed.

By checking your blood pressure correctly, speaking up during visits, and working closely with your care team, you can help protect your heart, brain, kidneys, and long-term health.

References

American Heart Association. The American Heart Association PREVENT™ Online Calculator. Professional Heart Daily. Published 2023. Accessed September 10, 2025. https://professional.heart.org/en/guidelines-and-statements/prevent-risk-calculator/prevent-calculator

American Heart Association. Home blood pressure monitoring. Updated 2025. Accessed September 10, 2025. https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings/monitoring-your-blood-pressure-at-home

American Heart Association Newsroom. Only 1 in 7 online health images show proper technique to accurately measure blood pressure. Published September 8, 2025. Accessed September 12, 2025. https://newsroom.heart.org/news/only-1-in-7-online-health-images-show-proper-technique-to-accurately-measure-blood-pressure

Iadecola C, Yaffe K, Biller J, Bratzke LC, Faraci FM, Gorelick PB, Gulati M, et al; American Heart Association Council on Hypertension; Council on Clinical Cardiology; Council on Cardiovascular Disease in the Young; Council on Quality of Care and Outcomes Research; and Stroke Council. Impact of hypertension on cognitive function: A scientific statement from the American Heart Association. Hypertension. 2016;68(6):e67-e94. doi:10.1161/HYP.0000000000000053

Jones DW, Ferdinand KC, Taler SM, Johnson HM, Shimbo D, Abdalla M, Williamson JD, et al. 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM guideline for the prevention, detection, evaluation and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2025;152(11):e1-e239. doi:10.1161/CIR.0000000000001356.

National Heart, Lung, and Blood Institute. DASH eating plan. Updated January 10, 2025. Accessed September 10, 2025. https://www.nhlbi.nih.gov/education/dash-eating-plan

Vasan RS, Song RJ, Xanthakis V, Beiser A, DeCarli C, Mitchell GF, Seshadri S. Hypertension-mediated organ damage: Prevalence, correlates, and prognosis in the community. Hypertension. 2022;79(3):501-510. doi:10.1161/HYPERTENSIONAHA.121.18502