New AHA hypertension guidelines call for less salt, no alcohol

• Hypertension, or high blood pressure, affects around one in every three adults worldwide.
• It is a risk factor for several health conditions, including heart attack, stroke, heart failure and kidney damage.
• The American Ηeart Association has recently updated its 2017 guidelines on the prevention and management of hypertension, including new research information for the 2025 guidelines.
• It advises that anyone can develop high blood pressure but that diet and lifestyle modifications can prevent or control the condition for many people.

The World Health Organization (WHO) states that one in three adults, or 1.3 billion people, around the world have hypertension, so preventing, detecting and treating it could prevent 76 million deaths worldwide between now and 2050.

Blood pressure is recorded as systolic, referring to the maximum pressure when the heart contracts, over diastolic — the minimum pressure just before the next contraction. Ideally, it should be 120/80 millimeters of mercury (mmHg) or below.

The full guidelines, published in the journal Hypertension, aim to help medical practitioners detect and treat hypertension, but also contain valuable advice to help people control and manage their own blood pressure.

Cheng-Han Chen, MD, board certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, CA, who was not involved in developing the guidelines, told Medical News Today that:

“The new blood pressure guidelines have several changes that emphasize earlier assessment and intervention of elevated blood pressure. In particular, it affirms the importance of lifestyle changes to help control blood pressure, such as with limiting sodium and alcohol intake, eating a heart healthy diet, maintaining physical activity, and managing weight and stress. This is a welcome message that will hopefully help us manage hypertension before it contributes to more serious cardiovascular disease.”

To update their guidelines, the AHA carried out a comprehensive review of clinical studies, reviews and other evidence about hypertension published since February 2015.

They describe the guidelines as a “living, working document updating current knowledge in the field of high blood pressure aimed at all practicing primary care and specialty clinicians who manage patients with hypertension.”

Daniel W. Jones, MD, FAHA, volunteer chair of the guideline writing committee and a past-president of the AHA (2007-2008), dean and professor emeritus of the University of Mississippi School of Medicine in Jackson, MS, and a member of the writing committee for the 2017 high blood pressure guideline, told MNT that:

“All adults should have their blood pressure measured at least once a year, more often for patients with any level of high blood pressure. Patients with high blood pressure who have a reading above 180/120 mmHg should seek advice from their clinician, urgently if there are symptoms of chest pain, shortness of breath, paralysis or speech difficulty.”

As part of the update, the AHA has also published a summary for patients of the top 10 things that people should know about high blood pressure.

Jones highlighted the key updates for 2025, which include:

1. the goal of achieving a systolic blood pressure of 130 mmHg or below, and ideally of 120 mmHg, for adults with high blood pressure
2. more clear and robust evidence that intensive lowering of blood pressure reduces the risk of cognitive decline and dementia
3. “in adults with an average blood pressure of 130/80 mm Hg [or more], and at lower 10-year cardiovascular dis­ease risk defined by the PREVENT risk calculator of <7.5%, initiation of medication therapy to lower blood pressure in addition to lifestyle modification are recommended if average blood pressure remains 130/80 mmHg [or more] after an initial 3- to 6-month trial of lifestyle modification only”
4. recommendations of “moving toward an ideal limit of 1500 mg/day [milligrams per day]” for sodium consumption
5. the advice to stop consuming, “or at least to reduce alcohol intake to [less than] 1 drink/day for women and [less than] 2 drinks/day for men to prevent or treat elevated blood pressure and hypertension.”

To this he added that “patients with high blood pressure who have a reading above 180/120 mmHg should seek advice from their clinician, urgently if there are symptoms of chest pain, shortness of breath, paralysis or speech difficulty,” Jones advised.

The AHA advises that anyone can develop high blood pressure, so it is important to have it checked regularly. It also states that although lifestyle and dietary changes can be effective in reducing blood pressure, many people will also need medications to get their blood pressure down to healthy levels.

“These new guidelines will hopefully encourage clinicians to further recommend lifestyle changes to patients with elevated blood pressure. They also promote the use of a specific risk calculator to help us determine which patients may benefit most from medical therapy for hypertension,” Chen told MNT.

“Some lifestyle recommendations for people trying to reduce blood pressure on their own include eating a heart healthy diet low in sodium, avoiding/eliminating alcohol intake, maintaining a healthy weight, getting regular physical activity, and managing their stress levels,” he added.

The guidelines also emphasize that losing at least 5% of your body weight if you have overweight or obesity can help lower or prevent hypertension, and advise that people can learn more about how to improve their heart and brain health from Life’s Essential 8, which is also published by the AHA.

“Nearly one of every two adults in the U.S. has high blood pressure, and it is the [number] one modifiable risk factor for [cardiovascular disease]. Every person has the opportunity to change the course of their future, their health — annual screening, prevention and early treatment for high blood pressure are the keys to a longer, healthier life.”

– Daniel W. Jones, MD, FAHA