What the New Blood Pressure Guidelines Mean for You
With February being Heart Health Month and cardiovascular death is the leading cause of death in women (the risk increasing after menopause,) I thought it would be an important time to understand the change in guidelines and an online tool to assess your risk.
High blood pressure is incredibly common in the United States and remains one of the biggest drivers of heart disease. In 2025, national experts updated the official blood pressure guidelines to better reflect what we now know about heart risk, brain health, and long-term prevention.
Here is what changed in plain language.
A Smarter Way to Measure Your Risk
Instead of using an older heart-risk calculator, doctors are now encouraged to use a newer tool called PREVENT, which looks at a wider range of heart problems, not just heart attack and stroke.
Because this tool captures more risk, more people may now qualify for treatment at lower blood pressure levels than before. In practical terms, this means that if your blood pressure is 130/80 or higher and your overall heart risk is moderate or above, your clinician may recommend medication sooner than in the past. If your risk is lower, you will usually try lifestyle changes first for three to six months before starting medication.
The goal is to prevent problems before they start rather than waiting until blood pressure is dangerously high.
Food, Salt, and Potassium
One of the more interesting updates is a recommendation to use potassium-based salt substitutes instead of regular salt. These can help lower blood pressure for many people.
However, this is not safe for everyone, especially if you have kidney disease or take medications that raise potassium levels, so you should talk with your clinician before making this change.
If Your Blood Pressure Is Hard to Control
If your blood pressure stays high despite taking multiple medications, the guideline says your care team should look deeper for hidden causes, review all your medications carefully, and consider whether any drugs you take might be making things worse.
In some cases, a procedure called renal denervation might be discussed, but this should only happen after evaluation by a specialized team and a thorough conversation about risks and benefits.
Blood Pressure and Your Brain
The new guideline specifically recommends keeping systolic blood pressure below 130 to lower the risk of memory problems and dementia later in life. Many people do not realize that midlife blood pressure is closely linked to brain health decades later.
Pregnancy and Blood Pressure
For pregnant women, the rules are clearer and more urgent. If blood pressure reaches 160/110, treatment should start quickly. Women with chronic high blood pressure should aim for under 140/90 during pregnancy. Low-dose aspirin is recommended for many women to reduce the risk of preeclampsia. Several common blood pressure medications are unsafe in pregnancy and should be avoided.
Big Picture
The 2025 guidelines move toward earlier prevention, smarter risk assessment, and more personalized care. If you have high blood pressure, these changes mean your clinician may look at your overall heart risk, your kidney function, your medications, and even your long-term brain health, not just your numbers in the moment.
Sources
Writing Committee Members; Jones DW, Ferdinand KC, Taler SJ, 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):e114–e218. doi:10.1161/CIR.0000000000001356
Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Hypertension. 2017;71(6):e13–e115. doi:10.1161/HYP.0000000000000065
World Health Organization. Guideline for the pharmacological treatment of hypertension in adults. 2021.
SPRINT Research Group; Wright JT Jr, Williamson JD, Whelton PK, et al. A randomized trial of intensive versus standard blood-pressure control. New England Journal of Medicine. 2015;373(22):2103–2116. doi:10.1056/NEJMoa1511939
