New Blood Pressures Guidelines August 2025

In August, 2025 American Heart Association (AHA) and American College of Cardiology (ACC) released an updated comprehensive guidelines for hypertension, aka high blood pressure. 

New August 2025 Blood Pressure Guidelines

• Release & Scope
• Issued August 14, 2025, the guideline is a comprehensive update jointly published by the American Heart Association (AHA), American College of Cardiology (ACC), and endorsed by 11 other major organizations.
• It replaces the 2017 guidelines and integrates the latest evidence to inform prevention, detection, evaluation, and management of hypertension in adults.
• Blood Pressure Categories
• Despite the updates, the numeric thresholds remained unchanged:
• Normal: <120/80 mm Hg
• Elevated: 120–129/<80 mm Hg
• Stage 1 Hypertension: 130–139/80–89 mm Hg
• Stage 2 Hypertension: ≥140/90 mm Hg
• Emphasis on Early & Personalized Intervention
• Encourages earlier treatment, combining lifestyle and medication sooner than before.
• Providers are urged to begin medication if lifestyle changes don’t improve blood pressure within 3–6 months
• Use of the PREVENT™ risk calculator, which estimates 10 and 30 year cardiovascular risk using multiple factors; including social and metabolic indicators and is strongly recommended to personalize care
• Stricter Lifestyle Recommendations
• Sodium intake: aim for <2,300 mg/day, ideally ≈1,500 mg/day. Here is my earlier post on sodium; Salt & Sodium
• Alcohol: Total avoidance is encouraged; if consumed, limit to two drinks/day (men), one drink/day (women)
• Reinforces the DASH (Dietary Approaches to Stop Hypertension) eating pattern, incorporating vegetables, fruits, whole grains, low-fat dairy, lean proteins, legumes, nuts, and seeds. Check out lentil/bean recipes: Lentil Soup; Chickpea Curry
• Weight: Target losing ≥5% of body weight for those overweight or with obesity
• Physical activity: 75–150 minutes/week of aerobic and/or resistance exercise
• Stress: Incorporate stress reduction via exercise, meditation, breathing exercises, or do yoga

• Enhanced Monitoring & Diagnostic Tools
• Home blood pressure monitoring is emphasized for diagnosing hypertension and tracking treatment effects
• Lab testing updates:
• Urine albumin-to-creatinine ratio is now recommended for all patients (previously optional)
• Aldosterone-to-renin ratio screening is expanded to include more patients, especially those with obstructive sleep apnea or stage 2 hypertension
• Focus on Brain Health & Cognitive Decline
• The guideline connects high blood pressure with cognitive impairment and dementia, urging early intervention. The treatment goal for adults with hypertension is now <130 mm Hg SBP to preserve brain health
• Pregnancy and Postpartum Considerations
• Emphasizes close monitoring and treatment before, during, and after pregnancy to reduce risks like preeclampsia, eclampsia, and long-term maternal cardiovascular issues 
• Recommends treating chronic hypertension in pregnant women when SBP ≥140 or DBP ≥90 mm Hg 
• Suggests low-dose aspirin (81 mg/day) for women planning pregnancy or pregnant to reduce preeclampsia risk 
• Encourages annual blood pressure monitoring postpartum for women with a history of pregnancy-related hypertension 

Comparison Table: 2017 vs. 2025 Guidelines

Feature	2017 Guidelines	2025 Guidelines (August 14, 2025)
Blood Pressure Categories	Normal: <120/80 Elevated: 120–129/<80 Stage 1: 130–139/80–89 Stage 2: ≥140/90	Unchanged categories; same thresholds remain
Treatment Timing	Based on category/risk; less emphasis on early med	More proactive: begin medication if no improvement after 3–6 months of lifestyle changes
Risk Assessment Tools	Based on traditional tools (e.g., ASCVD risk)	Introduces PREVENT™ 10 and 30 year risk calculator for personalized care
Lab Tests	Albumin-to-creatinine optional; limited screening	Albumin-to-creatinine now recommended for all; expanded aldosterone-to-renin testing
Lifestyle Emphasis	General recommendations (e.g., DASH, sodium)	Stronger: lower sodium, DASH, exercise, stress reduction, alcohol avoidance, weight loss
Home BP Monitoring	Recommended as helpful	Emphasized as key for diagnosis and treatment tailoring
Cognitive Health	Not specifically addressed	Explicit link: early BP control (<130 SBP) to protect cognition/dementia prevention
Pregnancy Management	General guidance	Detailed: thresholds for treatment (≥140/90), aspirin use, postpartum monitoring

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The August 14, 2025 AHA/ACC blood pressure guideline builds upon the 2017 framework; maintaining established numeric thresholds; while reinforcing a more aggressive and personalized treatment approach. Key points;

• Earlier intervention, blending lifestyle changes with medication when necessary, guided by the new PREVENT™ risk calculator.
• Tighter lifestyle control; stricter sodium and alcohol limits, emphasizing DASH diet, exercise, weight loss, and stress management.
• Enhanced monitoring via home tracking and expanded lab assessments to support accurate diagnosis and tailored treatment.
• New focus on cognitive health, recognizing the role of blood pressure control in preventing dementia.
• Addressing hypertensive care in pregnancy and postpartum, complete with clear thresholds and preventive measures like aspirin.

Together, these updates aim to proactively target prevention and improve long-term outcomes; from heart and kidney health to brain function and maternal well-being. 

Let's continue to love our heart and take care of our health 💕

Source: American Heart Association (www.heart.org)