Dec. 12, 2025

Blood Pressure & Updated Guidelines

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Show Notes

Stan, Clarence, Barry, and the Health Chatter team chat with Dr. Steve Kopecky, Professor of Medicine and Preventive Cardiologist at Mayo Clinic, about blood pressure and the updated guidelines.

Dr. Kopecky is a consultant and chair of education in the Division of Preventive Cardiology within the Department of Cardiovascular Medicine at Mayo Clinic in Rochester, Minnesota. He also serves as director of the Familial Hypercholesterolemia Clinic, Statin Intolerance Clinic, and the Cardiovascular Emergency Department Consult Service. A nationally and internationally recognized leader in cardiovascular disease prevention, Dr. Kopecky’s work focuses on the role of lifestyle in heart health and innovative treatments for elevated cholesterol, particularly in patients with genetic risk factors. He is the best-selling author of Live Younger Longer: 6 Steps to Prevent Heart Disease, Cancer, Alzheimer’s, Diabetes, and More, has published extensively in peer-reviewed journals, and serves on the editorial board of the Journal of Heart Health.

Join us for an enlightening discussion about what the new blood pressure guidelines mean for patients and clinicians, and stay tuned to gain fresh perspectives on how prevention, lifestyle, and early intervention can improve long-term heart health.

Join the conversation at healthchatterpodcast.com

Brought to you in support of Hue-MAN, who is Creating Healthy Communities through Innovative Partnerships.

More about their work can be found at https://www.huemanpartnershipalliance.org/

Research

Blood Pressure

The American College of Cardiology and the American Heart Association divide blood pressure into four general categories. Ideal blood pressure is categorized as normal.

Normal blood pressure. Blood pressure is lower than 120/80 mm Hg.
Elevated blood pressure. The top number ranges from 120 to 129 mm Hg and the bottom number is below, not above, 80 mm Hg.
Stage 1 hypertension. The top number ranges from 130 to 139 mm Hg or the bottom number is between 80 and 89 mm Hg.
Stage 2 hypertension. The top number is 140 mm Hg or higher or the bottom number is 90 mm Hg or higher.

New guidelines

The AMA and 10 other health care organizations have collaborated with the American Heart Association (AHA) and the American College of Cardiology (ACC) to update an influential guideline to prevent, detect, evaluate and manage high BP in adult patients. In some of the key updates, the new guideline—led by AHA/ACC and endorsed by the AMA and others—sets a minimum BP threshold for all patients to meet while confirming the association between lower BP and reduced dementia risk.

The new guideline retains 2017’s four BP categories for adults

The overarching BP treatment goal revises 2017 guidelines, asking physicians and other health professionals to achieve a target of less than 130/80 mm Hg for all patients, with encouragement to achieve less than 120 mm Hg. This applies to both young and older patients

One notable addition is the use of the PREVENT™ risk calculator, which helps health care professionals personalize care based on a patient’s long-term cardiovascular risk.
Pregnancy is another focus. The guideline offers tailored recommendations to protect both maternal and fetal health, recognizing the unique risks and treatment needs during this critical time.
It also emphasizes team-based care, including doctors, nurses, pharmacists, and community health workers, to overcome barriers and improve access to medications. Home blood pressure monitoring is also encouraged, though smartwatches and cuffless devices are not yet reliable enough for clinical use.

High Blood Pressure (Hypertension)

High blood pressure is a common condition that affects the body's arteries. It's also called hypertension. If you have high blood pressure, the force of the blood pushing against the artery walls is consistently too high. The heart has to work harder to pump blood.

Blood pressure is measured in millimeters of mercury (mm Hg). In general, hypertension is a blood pressure reading of 130/80 mm Hg or high
Blood pressure higher than 180/120 mm Hg is considered a hypertensive emergency or crisis. Seek emergency medical help for anyone with these blood pressure numbers.
Untreated, high blood pressure increases the risk of heart attack, stroke and other serious health problems. It's important to have your blood pressure checked at least every two years starting at age 18. Some people need more-frequent checks.

Symptoms

Most people with high blood pressure have no symptoms, even if blood pressure readings reach dangerously high levels. You can have high blood pressure for years without any symptoms.

A few people with high blood pressure may have:

Headaches
Shortness of breath
Nosebleeds
However, these symptoms aren't specific. They usually don't occur until high blood pressure has reached a severe or life-threatening stage.

Causes

There are two main types of high blood pressure.

Primary hypertension, also called essential hypertension

For most adults, there's no identifiable cause of high blood pressure. This type of high blood pressure is called primary hypertension or essential hypertension. It tends to develop gradually over many years. Plaque buildup in the arteries, called atherosclerosis, increases the risk of high blood pressure.

Secondary hypertension

This type of high blood pressure is caused by an underlying condition. It tends to appear suddenly and cause higher blood pressure than does primary hypertension. Conditions and medicines that can lead to secondary hypertension include:

Adrenal gland tumors
Blood vessel problems present at birth, also called congenital heart defects
Cough and cold medicines, some pain relievers, birth control pills, and other prescription drugs
Illegal drugs, such as cocaine and amphetamines
Kidney disease
Obstructive sleep apnea
Thyroid problems

Risk Factors

High blood pressure has many risk factors, including:

Age.
Race.
Family history.
Obesity or being overweight.
Lack of exercise.
Tobacco use or vaping.
Too much salt.
Low potassium levels.
Drinking too much alcohol.
Stress.
Certain chronic conditions. Kidney disease, diabetes and sleep apnea are some of the conditions that can lead to high blood pressure.
Pregnancy.

Complications

Heart attack — The arteries can become blocked and prevent blood flow to the heart muscle.
Stroke — Blood vessels that supply blood and oxygen to the brain to become blocked or burst.
Heart failure — High blood pressure makes the heart work harder. This can cause the heart to get bigger and struggle to pump enough blood to the body.
Kidney disease or failure — Damage in the arteries around the kidneys can stop them from filtering blood the right way.
Vision loss — Blood vessels in the eyes can get strained or damaged.
Sexual dysfunction — High blood pressure can lead to erectile dysfunction (not being able to have or maintain an erection) in men and may cause a lower sex drive in women.
Heart disease — Over time, high blood pressure can lead to heart disease. Angina is chest pain that is a common symptom.
Atherosclerosis (plaque buildup in the arteries) — High blood pressure can damage arteries in the body and allow plaque to build up.

Disparities

Nearly half of U.S. adults have high blood pressure, but the burden of disease is disproportionately higher in Black and Hispanic/Latino people.

In the U.S., hypertension rates among Black adults are among the highest in the world, affecting more than half of both men and women. Due to a history of systemic racism and structural inequities, Black communities have lower trust in the health care system, which necessitates a different approach to care.
Hispanic/Latino adults have lower rates of hypertension awareness, treatment and control rates compared to their white counterparts. Certain systemic barriers, including lack of access to health insurance, impede access to quality primary care for diagnosing, monitoring and treating hypertension.

Managing Blood Pressure

Lifestyle Changes - By making these lifestyle changes, you can help keep your blood pressure levels healthy.

Get regular physical activity. Staying physically active is one of the best things you can do for your health. Physical activity helps keep your heart and blood vessels strong. It also can help you keep a healthy weight.
Do not smoke. Smoking damages your blood vessels and greatly increases your risk of not only high blood pressure but also heart disease, heart attack, and stroke.
Eat healthy foods. Choosing healthy meal and snack options can help you avoid high blood pressure and its complications. Be sure to eat plenty of fresh fruits and vegetables.
Keep a healthy weight. Having overweight or obesity means your heart must work harder to pump blood and oxygen around the body. Staying at a healthy weight reduces the stress on your heart and reduces your risk for heart disease, heart attack, and stroke.

Medication

Many people need to take medicine in addition to making lifestyle changes to help keep their blood pressure at healthy levels. Your health care team may prescribe you one of many kinds of blood pressure medicines.

High blood pressure medicines are classified in the following groups: