A study in rural China demonstrating the power of intensive blood pressure control clinched the deal. The large, cluster-randomized controlled trial convincingly demonstrated that well-controlled blood pressure — below 130/80 mm Hg — lowered the risk of dementia by 15% and cognitive impairment by 16%.
That was the solid evidence reviewers needed to form the foundation for a new guideline from leading medical groups on how to treat high blood pressure, Dan Jones, chair of the guideline writing committee and a past president of the American Heart Association, told STAT. He called the study from China the first one to definitively show that rigorous lowering of blood pressure with a goal of below 120 systolic does decrease the risk of dementia.
“We don’t have recommended changes related to dementia but we are able to say with certainty that lowering blood pressure reduces the risk of dementia and that’s such good news for people around the world and for Americans,” said Jones, a former dean of the University of Mississippi School of Medicine.
The recommendations from the American Heart Association and the American College of Cardiology, announced Thursday, affirm under 120/80 as the healthy blood pressure goal for all U.S. adults, nearly half of whom now exceed 130/80.
In addition to citing hypertension’s impact on cognition, the recommendations encourage earlier treatment and underscore the known risks of high blood pressure before, during, and after pregnancy.
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““”We don’t have to tell patients to do something new,” Timothy Anderson, a primary care physician and an assistant professor of medicine at University of Pittsburgh Medical Center, said of the new advice. He was not involved in writing the guideline. “Instead, we just have to tell doctors to keep doing a better job of what we’re already trying to achieve in terms of goals.”
The 120/80 level was the “new normal” endorsed in 2017 by the professional organizations. It stood up to scrutiny for the 2025 guideline, derived from the more contemporary PREVENT risk assessment tool.
Released in 2023, PREVENT is considered an improvement on previous calculators because it used data from a much larger, more diverse database. Researchers, including Pitt’s Anderson, warned last year that applying the tool to manage high cholesterol could mean millions fewer American adults — 40% fewer than now — would be eligible for widely prescribed statins unless the threshold for treatment was also revised.
Jones said the 2025 blood pressure guideline, based on PREVENT, did use a different threshold for treatment than the 2017. The new cholesterol guideline, being prepared for release in 2026, will also introduce a new threshold for who should be put on statins or some other drug to lower their cholesterol, Jones said.
High cholesterol is one danger, but high blood pressure is the leading risk factor for cardiovascular disease, including heart attack, stroke, and heart failure, as well as kidney disease and dementia. While under 120 is best, the new recommendations advise starting management by bringing that top number below 130 — the cusp of stage 1 hypertension — in people who already have high blood pressure.
The guideline advises doctors to prescribe prevention to people with elevated numbers in the form of better diet, regular physical activity, and periodic monitoring of blood pressure. What’s new is the recommendation to begin treatment sooner — after three to six months — to lower blood pressure if those lifestyle changes don’t improve the numbers. Combining two blood pressure drugs is advised in some cases and low-dose aspirin is suggested during pregnancy.
““”Fewer than 30% of our patients who have high blood pressure are controlled to 130 or less for their average blood pressure,” Jones said about the top number. “We want to say clearly that the evidence supports 120, but let’s at least try to get people to less than 130.”
The advice for pregnant patients echoes what other national organizations have said about elevated blood pressure during pregnancy, a danger that is also tied to long-term risk of high blood pressure and cardiovascular disease. Including this guidance on when to take low-dose aspirin to reduce the risk of pre-eclampsia and eclampsia is intended to heighten awareness among primary care physicians who may read heart guidelines but not obstetric ones, Jones said.
Doctors might also consider obesity drugs like GLP-1s, the guideline says. Losing weight, with or without medication, is an effective strategy for reducing blood pressure, Anderson noted, and GLP-1 drugs are included in the 2024 recommendations from the American Stroke Association.
Jones also zeroed in on salt in the diet. The guideline reaffirms an ideal limit of 1,500 mg per day and suggests people consider potassium-enriched salt substitutes to lower sodium and fruits, juices, vegetables, and legumes to add potassium. Potassium helps the body flush out sodium and also relaxes tension in blood vessel walls, leading to lower blood pressure.
In this case, Jones said, evidence from China might not be helpful.
“In China and in India, most of the sodium that’s in the diet is in food prepared at home,” he said. “For Americans, most of the sodium in their diet is in foods prepared in the restaurants and in processed foods, sadly.”
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.
