New BP guidelines lower the target rate yet again

In accordance with new guidelines, doctors are putting increased emphasis on addressing high blood pressure among lower-risk people – and starting treatment sooner.

A report from the American College of Cardiology and the American Heart Association Joint Committee on Clinical Practice Guidelines recommends that everyone maintain a blood pressure below 130/80, and preferably lowering it to a target of under 120/80. Compared to the previous guidelines released in 2017 (that defined hypertension as 140/90 and above, and a healthy target of 130/80), the goal blood pressures are similar, but there is now more of an emphasis on earlier, more aggressive intervention, said Falmouth cardiologist John C. Hostetter, MD, FACC.

Patients with no history of stroke or heart attack and who don’t have diabetes or chronic kidney disease, but come in with a blood pressure of 130/80 or above will now be encouraged to lower their numbers through weight loss, exercise, stress reduction and reducing salt and alcohol intake, even if their estimated 10-year risk of a cardiovascular event is less than 7.5 percent, Dr. Hostetter said. A reading of 130-139/80 is now considered Stage 1 hypertension.

If, after three months, the patient has not reached the target numbers, they will be prescribed medication, he said.

He contrasted that with the less aggressive approach formerly taken with these patients, which may have given them a longer window of time to lower their numbers with lifestyle changes.

“Patients would come in and say they’ll do better next time,” said Dr. Hostetter, who practices at Cape Cod Healthcare’s Cardiovascular Centers at Falmouth Hospital’s medical office building and Stoneman Outpatient Center in Sandwich. Now, “we’re not waiting to treat,” he said.

Medication is indicated for anyone with a blood pressure of 140/90 and for some whose numbers are equal to or greater than 130/80 and have cardiovascular disease, diabetes, chronic kidney disease or had a stroke, or whose estimated 10-year risk of a cardiovascular event is 7.5 percent or higher, according to the new guidelines, which were published in both the AHA’s journal Circulation and the Journal of the American College of Cardiology on Aug. 14, 2025.

Why the Change?

Both the prevalence and dangers of high blood pressure drive the new approach.

“Studies support (the fact that) 40-50 percent of Americans are hypertensive,” Dr. Hostetter said.

According to the report, high blood pressure is the most common contributor to cardiovascular disease, which includes stroke, atrial fibrillation and heart failure, but also chronic kidney disease and dementia, and death from any cause. It is also the factor most able to be changed, whether it be through a healthier lifestyle or medication. Yet, unless someone has their blood pressure taken, they may be unaware they have the condition or are at risk of developing it.

Hypertension doesn’t typically cause symptoms until someone suffers a cardiovascular event, Dr. Hostetter said.

“For every 10 points you’re too high with systolic blood pressure (the larger first or top number in a blood pressure reading that indicates pressure on blood vessel walls during heart beats), your risk of stroke goes up 27 percent, your risk of heart failure goes up 28 percent and about 20 percent for all major cardiovascular events. Mortality goes 14 percent higher,” he said.

Dr. Hostetter noted that the updated guidelines refer to the increased risk of dementia and loss of cognitive ability posed by hypertension.

“Nobody wants a heart attack, and nobody wants dementia or a stroke. The linking of hypertension to cognitive decline is a big motivator,” for patients, he said.

Patients should also be aware that long-term hypertension can damage the kidneys, he said, and “dialysis is a very real risk in people with high blood pressure.”

How to Reduce Your Risk

“If you lose 10 pounds, you can drop your systolic blood pressure 4-5 points,” Dr. Hostetter said.

He suggested that people:

• Exercise 30-45 minutes 4-5 times a week.
• Drop salt intake to 2,300 mg day – the average American consumes 3,500 mg daily, he said.
• Restrict alcohol consumption to one drink per day for women and two for men or less.

Medication, if prescribed, may include a calcium channel blocker, an ACE inhibitor or a diuretic. Two may be combined in one pill to make them easier to take.

Patients who excuse a high reading in a doctor’s office should be aware that a diagnosis is based upon more than one result, he said.

“If your blood pressure is up because of stress from traffic (getting to the doctor), it’s probably up during the day, as well.”