The next time you have your blood pressure checked, don’t be surprised if your healthcare provider seems more proactive about dealing with high readings. And if you enjoy a glass of wine with dinner or a drink on weekends, well, the latest guidelines from the American Heart Association and the American College of Cardiology suggest it might be time to reconsider that habit.
These organizations regularly review recent studies to help medical professionals determine the best strategies for managing high blood pressure. This update is notable as it’s the first major revision since 2017. Given that heart disease remains the leading cause of death worldwide, managing blood pressure is critical. Keeping it in check can also help lower the risk of complications like kidney disease, type 2 diabetes, and even dementia.
In the U.S., nearly half of all adults have elevated blood pressure. The target numbers haven’t changed: normal is under 120/80 mm Hg, while elevated ranges from 120 to 129/80 mm Hg. If your readings hit 130/80 mm Hg or above, expect your provider to recommend changes.
Blood pressure readings consist of two numbers: the systolic (the upper number that indicates pressure when the heart pumps) and the diastolic (the lower number that measures pressure when the heart is at rest).
Often, high blood pressure sneaks up without symptoms. But when it is high, it forces your heart and blood vessels to work harder, potentially leading to serious issues like heart attacks or strokes if left untreated.
Approaches to Managing High Blood Pressure
The new guidelines suggest that if your systolic blood pressure falls between 130 and 139, your healthcare provider should start by recommending lifestyle changes rather than jumping straight to medication. After a few months, if those changes aren’t effective, medication becomes the next step. This is a shift from the previous 2017 advice that called for immediate medication for anyone above 140.
“The goal here is to control blood pressure more effectively to protect people from cardiovascular risks and conditions like dementia, which we’ve learned is also impacted by blood pressure,” said a representative from the American Heart Association.
According to these new guidelines, healthy lifestyle changes include reaching or maintaining a healthy weight, adopting a heart-healthy diet, cutting back on salt, managing stress, and getting regular moderate physical exercise—around 150 minutes weekly—alongside resistance training like weightlifting.
Another notable change is the fresh recommendation regarding alcohol: abstaining altogether is now encouraged.
Previously, the guidance allowed for up to one drink per day for women and two for men, but recent findings indicate that alcohol can worsen blood pressure. “People enjoy drinking, and we understand that; we just want them to make informed choices,” the representative added, recognizing that individual responses to alcohol can vary.
Evidence has increasingly suggested that lowering blood pressure plays a significant role in reducing the risk of dementia as well.
With rising concerns regarding high blood pressure during pregnancy, the guidelines have also highlighted the importance of monitoring blood pressure for those planning to become pregnant or currently pregnant. Elevated blood pressure can pose risks during pregnancy and might lead to issues long after childbirth.
Diet recommendations continue to emphasize the DASH diet, which focuses on fruits, vegetables, whole grains, lean proteins, and healthy fats while limiting unhealthy fats and sugars.
“We also reemphasize the importance of sodium reduction. It’s a staple for many, but we advocate for limiting salt intake while increasing potassium,” the spokesperson explained. Using potassium-enriched substitutes is a handy tip for home cooking. Ideally, daily sodium intake should be kept below 2,300 mg, with a target closer to 1,500 mg.
For individuals who are overweight or obese, losing at least 5% of body weight is recommended. For those facing severe obesity, clinically proven interventions including proper diet, exercise, and possibly weight loss medications are suggested. In extreme cases, surgery may also be considered.
While it can be challenging to manage blood pressure, these steps can lead to substantial health improvements.
“The reality is that the fundamentals of prevention and treatment hinge on eating habits—and our current food environment can make that tough. It’s not easy to maintain low sodium or adequate potassium levels, but the good news is that it’s effective if you commit to it,” the representative noted. “It’s tough, but it’s worthwhile.”
