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Treat Hypertension Earlier and Avoid Alcohol, New Guidelines Recommend

Experts say earlier high blood pressure treatment could lower the risk of heart attack, stroke, and even dementia.

Your doctor may soon recommend medication and teetotaling for even slightly high blood pressure, according to new guidelines from the American Heart Association (AHA) and the American College of Cardiology.


“High blood pressure is the most common modifiable risk factor for cardiovascular disease — including heart attack, stroke, and heart failure, as well as kidney disease, cognitive decline, and dementia,” says Daniel W. Jones, MD, who served as chair of the guidelines writing committee.

There are two major reasons for the latest recommendations, says Dr. Jones, a fellow of the AHA and dean and professor emeritus of the University of Mississippi School of Medicine in Jackson: “First, we understand that the damage to blood vessels in the heart, kidney, and brain occurs at lower levels of blood pressure and at a younger age. Secondly, in most people, blood pressure rises with age. Beginning medication at an earlier stage slows the rise in blood pressure with age.”

Don’t Wait to Treat High Blood Pressure

Experts define high blood pressure, also called hypertension, as having systolic pressure (or the top number on a blood pressure reading) higher than 130 millimeters of mercury (mmHg), and diastolic pressure (the bottom number on a blood pressure reading) higher than 80 mmHg.

While the 2025 guidelines don’t make adjustments to these numbers, they do recommend adding medication therapy for people with stage 1 hypertension (a systolic blood pressure reading of 130 to 139 mmHg) if three to six months of lifestyle changes don’t bring blood pressure down to a normal range. The previous guidelines, last issued in 2017, recommended only lifestyle therapy at that stage.


“Heart health experts have been concerned about the risk of high blood pressure for decades,” says Jones. “What is new is the growing evidence that intensive lowering of systolic blood pressure to less than 130 or 120 mmHg reduces the risk of heart disease more than the older standard of less than 140 mmHg,” he says.

Alcohol Can Contribute to High Blood Pressure

The updated guidelines also suggest that avoiding alcohol is ideal — as research demonstrates that even small amounts of alcohol consumption can lead to elevated blood pressure. According to research cited in the guidelines, avoiding alcohol altogether results in the lowest risk of high blood pressure, while reducing alcohol intake by at least half can lead to normal blood pressure levels.

“The guidelines have long recommended no more than one drink a day for women, and no more than two drinks per day for men,” says Luke Laffin, MD, co-director of the Center for Blood Pressure Disorders at the Cleveland Clinic in Ohio. “However, the current guidelines emphasize that any degree of alcohol consumption can increase blood pressure,” says Dr. Laffin, who wasn’t involved in drafting the new recommendations.

“We want the public to know the evidence so that informed decisions can be made,” adds Jones.

Closer Blood Pressure Monitoring During Pregnancy

The 2025 guidelines also recommend closer hypertension monitoring before, during, and after pregnancy to help mitigate the risk of short- and long-term complications. They advise treating high blood pressure with certain medications when systolic blood pressure measures 140 mmHg or higher, or diastolic blood pressure reaches 90 mmHg or more.

“High blood pressure during pregnancy can have lasting effects on the mother’s health, including an increased risk of future high blood pressure and cardiovascular conditions. Without treatment, high blood pressure during pregnancy can lead to serious complications, such as preeclampsia, eclampsia, stroke, kidney problems, and premature delivery. Women with high blood pressure on medication who are planning a pregnancy should discuss best medication choices with their clinician prior to becoming pregnant,” says Jones.

Healthy Lifestyle Habits Can Make a Big Difference for Blood Pressure

The guidelines still highlight the importance of heart healthy lifestyle habits, which have been shown to be effective in preventing and treating high blood pressure.

“Lifestyle has always been paramount to hypertension treatment,” says Laffin. “Treatment is actually 70 percent lifestyle modification, 30 percent medications. Most people with high blood pressure need medications, but lifestyle modification is needed in all patients.”

The AHA recommends the following habits as a first line of hypertension treatment for all adults:


  • Eat less than 2,300 milligrams (mg) of sodium per day, and aim for an ideal limit of 1,500 mg daily.
  • Give up alcohol or reduce intake to no more than two drinks per day for men and no more than one drink per day for women.
  • Practice stress management techniques such as yoga, meditation, or breathwork.
  • Move your body to get 75 to 150 minutes of moderate to vigorous intensity exercise per week. Try to incorporate at least two sessions of resistance or strength training.
  • Follow a heart healthy diet, like the DASH-style eating plan which is designed to lower high blood pressure, and focuses on eating plenty of fruits, vegetables, whole grains, beans, nuts and seeds, lean protein, and low-fat dairy.
  • Maintain or work toward a healthy body weight, with a goal of losing at least 5 percent of total body weight in people who are overweight or have obesity.
  • Monitor your blood pressure at home, which can help track progress and tailor care.

Who Is Most at Risk for Developing High Blood Pressure — and Why Is It So Dangerous?

Data suggests that almost half of all adults in the United States have high blood pressure, but many don’t realize they have it because there are typically no noticeable signs or symptoms.


What’s more, virtually anyone can develop high blood pressure, though the risk can be higher when certain factors are at play — like a family history of the disease, or having a health condition like diabetes, sleep apnea, or thyroid disease.

And in addition to the more well-known heart health complications of high blood pressure, the guidelines point out that research has more recently linked heart disease to a decline in brain health — making early detection and treatment for high blood pressure even more crucial.

“We’ve always been concerned about the risks of high blood pressure,” says Laffin. “But we are even more sure now that controlling blood pressure to lower levels is associated with a reduced cardiovascular risk and lower risk of mild cognitive impairment and dementia.”

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