Blood Pressure - Life's Essential 8 Health Factor
Summary
Nearly half of all adults in the U.S. have high blood pressure (≥130/80 mm Hg), which is the #1 preventable risk factor for cardiovascular disease. A joint guideline from the American Heart Association and the American College of Cardiology advises earlier treatment that includes lifestyle modification and medications as appropriate, recommends close blood pressure management before, during and after pregnancy, and highlights using the American Heart Association PREVENT™ equations to estimate a person’s cardiovascular disease risk to tailor treatment. Key details listed below.
High Blood Pressure
High blood pressure (including stage 1 or stage 2 hypertension) affects nearly half (46.7%) of all adults in the U.S. and is the leading preventable risk factor for heart disease, the leading cause of death in the U.S. and around the world.
The blood pressure criteria remain the same as the 2017 guideline:
- normal blood pressure is less than 120/80 mm Hg;
- elevated blood pressure is 120-129 mm Hg and <80 mm Hg;
- stage 1 hypertension is 130-139 mm Hg or 80-89 mm Hg; and
- stage 2 hypertension is ≥140 mm Hg or ≥90 mm Hg.
Importance of healthy lifestyle
Healthy lifestyle behaviors play a critical role in preventing and managing high blood pressure. Working with a health care professional, patients can set realistic, achievable goals. Healthy behaviors such as those in Life’s Essential 8™, the American Heart Association’s metrics for heart health, remain the first line of care for all adults.
Specific blood pressure-related guidelines include:
- Limiting sodium intake to less than 2,300 mg per day, moving toward an ideal limit of 1,500 mg per day by checking food labels (most adults in the U.S. get their sodium from eating packaged and restaurant foods, not the salt shaker);
- Ideally, consuming no alcohol or for those who choose to drink, consuming no more than two drinks per day for men and no more than one drink per day for women;
- Managing stress with exercise, as well as incorporating stress-reduction techniques like meditation, breathing control or yoga;
- Maintaining or achieving a healthy weight, with a goal of at least a 5% reduction in body weight in adults who have overweight or obesity;
- Following a heart healthy eating pattern, for example the DASH eating plan, which emphasizes reduced sodium intake and a diet high in vegetables, fruits, whole grains, legumes, nuts and seeds, and low-fat or nonfat dairy, and includes lean meats and poultry, fish and non-tropical oils;
- Increasing physical activity to at least 75-150 minutes each week including aerobic exercise (such as cardio) and/or resistance training (such as weight training); and
- Home blood pressure monitoring is recommended for patients to help confirm office diagnosis of high blood pressure and to monitor, track progress and tailor care as part of an integrated care plan.
Addressing each of these lifestyle factors is especially important for people with high blood pressure and other major risk factors for cardiovascular disease because it may prevent, delay or treat elevated or high blood pressure.
New risk equation and earlier intervention
The guideline recommends that health care professionals use American Heart Association PREVENTTM equations to estimate a person’s risk of a heart attack, stroke or heart failure.
Developed by the American Heart Association in 2023, the PREVENT equations are a tool to estimate 10- and 30-year risk of cardiovascular disease in people ages 30-79 years. It includes variables such as age, sex, blood pressure, cholesterol levels and other optional health indicators, including zip code as a proxy for social drivers of health.
It is the first risk calculator that combines measures of cardiovascular, kidney and metabolic health to estimate risk for cardiovascular disease.
More precise risk estimates can help guide treatment decisions personalized for each individual.
Association of high blood pressure with cognitive decline and dementia
- High blood pressure can damage small blood vessels in the brain, which is linked to memory problems and long-term cognitive decline.
- The guideline recommends early treatment for people diagnosed with high blood pressure with a goal of systolic blood pressure (top number) goal of <130 mm Hg for adults with high blood pressure to prevent cognitive impairment and dementia.
Tailored approaches to medication for high blood pressure
- For many people with high blood pressure more than one medication may be needed to lower blood pressure to meet the <130/80 mm Hg criteria.
- The guideline highlights several types of blood pressure medications to initiate treatment, including angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), long-acting dihydropyridine calcium channel blockers and thiazide-type diuretics. If blood pressure remains high after one medication, clinicians may individualize treatment to either increase the dose or add a second medication from a different medication class.
- The guideline maintains the recommendation to begin treatment with two medications at once – preferably in a single combination pill - for people with blood pressure levels 140/90 mm Hg or higher (stage 2 hypertension). The guideline also suggests possible addition of newer therapies such as GLP-1 medications for some patients with high blood pressure and overweight or obesity.
High blood pressure and pregnancy
- 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/or premature delivery. Women with high blood pressure who are planning a pregnancy or are pregnant should be counseled about the potential benefits of low-dose aspirin (81 mg/day) to reduce the risk of preeclampsia.
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How to lower your risk for cardiovascular disease
- Know your numbers and follow the American Heart Association’s Life’s Essential 8™
- Health Behaviors: Eat better, be active, quit tobacco, get healthy sleep.
- Health Factors: Manage weight, control cholesterol, manage blood sugar, manage blood pressure.
Please consult with your physician or healthcare team about what is best for your health.
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About the American Heart Association
The American Heart Association is a relentless force for a world of longer, healthier lives. Dedicated to ensuring equitable health in all communities, the organization has been a leading source of health information for more than one hundred years. Supported by more than 35 million volunteers globally, we fund groundbreaking research, advocate for the public’s health, and provide critical resources to save and improve lives affected by cardiovascular disease and stroke. By driving breakthroughs and implementing proven solutions in science, policy, and care, we work tirelessly to advance health and transform lives every day. Connect with us on heart.org, Facebook, X or by calling 1-800-AHA-USA1.
For Media Inquiries and American Heart Association Expert Perspective:214-706-1173; AHAcommunications@heart.org
For Public Inquiries: 1-800-AHA-USA1 (242-8721)
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