New 2025 blood pressure guidelines have made it easier to qualify for medication by lowering risk thresholds and blood pressure targets.
The Centers for Disease Prevention & Control (CDC) reports that about half (45%) of all adults have high blood pressure (hypertension) or take medication for it. Of these, only 1 in 4 adults are reported as having their blood pressure (BP) in control. These trends cost the country an average of $131 billion each year between 2003 to 2014.
In 2025, the American College of Cardiology and the American Heart Association released new guidelines for management of hypertension. This marks some significant changes since the previous guidelines were released in 2017. Today, let’s review these changes.
Earlier intervention for high-risk groups
The BP goal for most adults remains <130/80 mm Hg, but the 2025 guideline emphasizes earlier and more aggressive intervention, particularly in high-risk groups. The threshold for initiating antihypertensive medications in adults without clinical cardiovascular disease (CVD) but with diabetes, chronic kidney disease (CKD), or increased 10-year CVD risk, has been lowered. The 2017 guideline recommended starting medication at a 10-year ASCVD risk ≥10%, whereas the 2025 guideline uses a lower threshold of ≥7.5%. The ASCVD risk calculator is a tool used by clinicians to estimate the risk of a patient having a serious cardiovascular event like a heart attack in the next ten years.
Lower BP targets, new lifestyle interventions
For adults with lower CVD risk (<7.5%), the 2025 guideline recommends medication initiation if systolic blood pressure (SBP) remains ≥130 mm Hg or diastolic blood pressure (DBP) remains ≥80 mm Hg after 3-6 months of lifestyle intervention. The 2017 guideline used a higher threshold of SBP ≥140 mm Hg or DBP ≥90 mm Hg for this group.
For patients with diabetes or CKD, the 2025 guideline strengthens the recommendation for specific medications (ACE inhibitors or ARBs) if CKD is present. Additionally, the 2025 guideline introduces new recommendations for lifestyle interventions, such as the use of potassium-based salt substitutes, and updates terminology.
In summary, these recommendations mean that many more people could meet criteria to start blood pressure-lowering medications. Meet with your provider to learn more about how these changes might impact you.
Schedule a community BP screening
Healthy communities start with prevention. Primary.Health empowers public health, employers, and private entities to offer affordable, accessible screenings for blood pressure, cholesterol, diabetes, and more in local venues. Get the details from our Health team.
Disclaimer: This blog content and linked materials are not intended as individual medical advice, diagnosis or treatment, and should not be considered as such. Any readers with medical concerns should contact a licensed healthcare provider. This blog is provided for informational purposes only.
