What’s New with Blood Pressure Management

High blood pressure remains one of the biggest drivers of heart disease and stroke — but the way we approach treatment continues to evolve. The American College of Cardiology and American Heart Association recently updated their guidelines (2025), and there are a few important changes worth knowing.

Lower Is Better

The new goal for most adults with high blood pressure is below 130/80. In fact, if it can be done safely, doctors may aim to bring the top number (systolic blood pressure) down to below 120. Why? Because new research shows that tighter control lowers the risk of heart attack, stroke, and kidney disease.

When to Start Medicine

Deciding when to start blood pressure medication is now based on more than just the numbers. Doctors will use a new risk calculator, called PREVENT, to estimate your 10-year risk of heart disease or stroke.

• If your risk is 7.5% or higher, or you have diabetes or kidney disease, treatment usually starts when your blood pressure is 130/80 or above.

• If your risk is lower, lifestyle changes come first. Medication may be added later if your blood pressure stays above target after 3–6 months.

Lifestyle Still Comes First

The basics haven’t changed:

• Eat less salt and more potassium (though people with kidney problems need to be careful).

• Get regular physical activity.

• Maintain a healthy weight.

• Limit alcohol.

A newer tip: potassium-based salt substitutes can help lower blood pressure, but again, they’re not right for everyone.

Medications and Combinations

The main blood pressure medicines remain the same:

• Thiazide diuretics

• Calcium channel blockers

• ACE inhibitors or ARBs

If your blood pressure is very high — more than 20/10 above your goal — doctors may start with two medicines right away, often in a single combination pill to make it easier to take.

Screening for Hidden Causes

One important update: people with resistant hypertension (blood pressure that stays high despite several medications) should now all be screened for a condition called primary aldosteronism, even if their potassium levels are normal.

The Bottom Line: The new guidelines emphasize that controlling blood pressure earlier and aiming a little lower can save lives. But treatment should always be personalized — taking into account your overall risk, other health conditions, and how you tolerate therapy.