New Heart Guidelines Call for Stricter Blood Pressure Control and Alcohol Abstinence

Starting now, doctors may take a firmer approach to managing high blood pressure, and enjoying that nightly glass of wine or weekend cocktail could be discouraged. The American Heart Association (AHA) and the American College of Cardiology (ACC) released updated blood pressure guidelines on Thursday, their first since 2017.

The new guidelines reflect the latest research aimed at helping medical providers reduce heart disease—the world’s leading cause of death—by controlling one of its most modifiable risk factors: blood pressure. Proper management can also lower the risk of kidney disease, type 2 diabetes, and dementia.

Nearly half of U.S. adults have elevated blood pressure. While the definition of “normal” remains the same—less than 120/80 mmHg, with 120–129/80 mmHg considered elevated—patients with readings of 130/80 mmHg or higher are now urged to take action.

Blood pressure measures the force of blood against arterial walls, expressed as systolic (pressure while the heart beats) over diastolic (pressure while the heart rests) in millimeters of mercury (mmHg). High blood pressure often has no symptoms but strains the heart and arteries, raising the risk of heart attack and stroke.

Updated Treatment Approach

For patients with systolic pressure between 130–139 mmHg, doctors should first recommend lifestyle changes. If blood pressure remains high after three to six months, medication may be prescribed—a shift from the 2017 guidelines, which suggested medication only for readings above 140 mmHg.

Lifestyle changes include maintaining a healthy weight, following a heart-healthy diet, reducing salt intake, managing stress, getting at least 150 minutes of moderate exercise weekly, and including resistance training.

A notable update is the recommendation to avoid alcohol. Previously, moderate drinking was considered acceptable—up to one drink per day for women and two for men. Research now shows alcohol can negatively affect blood pressure, prompting the guideline’s shift toward abstinence, with lower limits for those who choose to drink.

Focus on Brain Health and Pregnancy

The new guidelines also highlight that lowering blood pressure may reduce dementia risk. Additionally, women planning pregnancy or already pregnant are encouraged to monitor blood pressure closely, as elevated readings can harm both mother and child and increase long-term risk.

Dietary guidance still emphasizes the DASH diet—rich in fruits, vegetables, whole grains, fish, poultry, beans, nuts, and vegetable oils, while low in fat, sugar, and tropical oils. Sodium intake should ideally be below 1,500 mg daily, with a maximum of 2,300 mg. Increasing potassium intake through home cooking and salt substitutes is also recommended.

For those with overweight or obesity, a weight loss of at least 5% is advised. More severe cases may require diet, exercise, weight-loss medications like GLP-1s, or even surgery.

Dr. Daniel Jones, chair of the AHA writing committee, acknowledges these steps can be challenging but emphasizes their effectiveness:

“It’s hard, but it works. Eating well, reducing sodium, and managing weight can dramatically improve your health if you commit to it.”