Reading the current blood pressure guidelines

To prevent a heart attack, stroke, and cognitive decline, aim for a blood pressure reading below 130/80 mm Hg — and ideally less than 120/80 mm Hg. That’s according to the current blood pressure guidelines from the American Heart Association (AHA) and American College of Cardiology.

Nearly half of adults in the United States have blood pressure readings of 130/80 mm Hg (the threshold for stage 1 hypertension) or higher (see “Blood pressure categories”). Lifestyle changes can help reduce blood pressure, but if you don’t reach your goal after three to six months, it’s time to start medication, says Dr. Randall Zusman, director of the Division of Hypertension at the Harvard-affiliated Massachusetts General Hospital Heart Center.

“People with stage 1 hypertension are twice as likely as people with normal blood pressure to have a heart attack or stroke,” says Dr. Zusman. As the 2025 guideline now points out, high blood pressure is also strongly linked to a higher risk of cognitive decline and dementia, he adds.

What changed in the new blood pressure guidelines?

While the 130/80 target is not new (it was first introduced in 2017), the latest guidelines include a few key updates, including a switch to the AHA’s PREVENT risk calculator. Its estimate of a person’s risk of heart disease over the next 30 years enables earlier and more precise treatment decisions.

People with stage 2 hypertension should start medical treatment right away. So should people with stage 1 hypertension who have either a 10-year cardiovascular disease risk of 7.5% or greater (based on the PREVENT calculator) or have diabetes or kidney disease.

The guidelines also feature detailed advice about blood pressure treatment, which includes four classes of drugs deemed first-line options: ACE inhibitors, angiotensin-receptor blockers (ARBs), calcium-channel blockers, and diuretics.

When are lifestyle changes recommended?

Lifestyle changes are recommended for all adults, but are particularly important for anyone with elevated blood pressure (120–129/<80 mm Hg) or higher. According to Dr. Zusman, these are the top five habits to lower blood pressure:

Eat less salt. Avoid ultra-processed foods and choose lower-sodium versions of products you eat regularly, such as cereals, soups, and sauces. Instead of salt, use alternative flavor boosters like garlic, pepper, cumin, or hot sauce.

Prioritize potassium. Follow a plant-forward eating pattern to get plenty of potassium, a mineral that helps lower blood pressure. Good sources include bananas, potatoes, tomatoes, and broccoli.

If you drink alcohol, do so mindfully. Abstinence isn’t necessary. But limit yourself to moderate amounts — no more than two drinks per day for men and one for women. For optimal blood pressure and overall health, the less alcohol intake the better.

Emphasize exercise. A combination of heart-pumping aerobic exercise (such as brisk walking, cycling, or swimming) and weight training (using your body weight, resistance bands, or dumbbells) is most effective. Strive for at least 30 minutes daily.

Practice the relaxation response. This state of profound rest that calms the nervous system can be elicited in many ways, including meditation, yoga, and progressive muscle relaxation.

How should you monitor your blood pressure at home?

Checking your blood pressure at home often provides a more realistic picture of your blood pressure than measurements taken at the doctor’s office. Here’s how to choose a home monitor, which shouldn’t cost more than $50 to $100.

• Measure the circumference of the middle of your upper arm to ensure a proper fit. A cuff that’s too small or too large won't give an accurate reading.
• Look for a device that has a large, easy-to-read display and a cuff that inflates automatically. Wrist or finger cuffs are not considered as reliable, nor are the new cuffless devices.
• Choose a monitor that appears on the American Medical Association’s Blood Pressure Validated Device Listing.
• Follow your doctor’s advice about when and how often to check your blood pressure at home. This video from the AHA demonstrates the correct technique.

*Symptoms: Chest pain, shortness of breath, back pain, numbness, weakness, change in vision, or difficulty speaking.
Source: American Heart Association.

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