Lead: On Sept. 7, 2025, new American Heart Association guidance and recent clinical data highlight that earlier treatment of high blood pressure — starting lifestyle changes and, when needed, medications once systolic readings exceed 130 mm Hg — can substantially lower risks of stroke, heart attack, kidney damage and dementia; an experimental aldosterone blocker, baxdrostat, also showed meaningful blood pressure reductions in people with hard-to-control hypertension.
Key takeaways
- New AHA guidance encourages earlier intervention for systolic blood pressure above 130 mm Hg to prevent cardiovascular and cognitive harms.
- Lifestyle measures — lower sodium, exercise, reduced alcohol and stress management — remain first-line for people with systolic readings in the 130s.
- For stage 2 hypertension (systolic ≥140 mm Hg), beginning medication promptly — often two drugs — is recommended.
- Many adults are unaware of high blood pressure; by age 40, over half of U.S. adults have hypertension.
- Baxdrostat, an aldosterone-blocking drug, reduced systolic pressure by about 10 mm Hg versus placebo in a trial of ~800 patients who remained hypertensive on 2–3 meds.
- A 10 mm Hg systolic drop is associated with roughly a 20% lower risk of heart attack and stroke and reduced dementia risk in population models.
Verified facts
The American Heart Association now emphasizes earlier detection and treatment of elevated blood pressure, advising diet and lifestyle changes once systolic pressure moves above 130 mm Hg, and medication when those measures do not achieve control. For systolic readings of 140 mm Hg or higher (stage 2), evidence supports starting pharmacologic therapy, often with two agents, to reach target ranges.
Hypertension is a major contributor to heart disease — the leading cause of death in U.S. men and women — and raises risks for kidney disease and cognitive decline by damaging small brain blood vessels. Clinical estimates link each 10 mm Hg decrease in systolic pressure to about a 20% reduction in heart attack and stroke risk.
| Category | Systolic (mm Hg) | Typical first-line approach |
|---|---|---|
| Elevated / borderline | 120–129 | Lifestyle (diet, exercise, alcohol moderation) |
| Stage 1 | 130–139 | Lifestyle; consider meds if risk factors or failure to improve |
| Stage 2 | ≥140 | Begin medication(s); lifestyle support |
A randomized trial published in the New England Journal of Medicine tested baxdrostat in about 800 participants whose blood pressure remained high despite two or three antihypertensive drugs. After 12 weeks, investigators reported an average ~10 mm Hg greater systolic reduction versus placebo. The study was sponsored by AstraZeneca, which indicated plans to submit data to regulators by year-end.
Context & impact
Many adults either lack a diagnosis or do not reach guideline blood pressure targets; more than half of people who know they have hypertension still do not achieve a reading ≤120/80 mm Hg. Barriers include medication side effects, variable drug response, limited adherence, and the prevalence of high-sodium processed foods.
Earlier, more aggressive management could shift population health by lowering rates of stroke, heart attack and dementia years from now. New drug classes that target aldosterone may expand options for people whose blood pressure remains uncontrolled on existing agents.
- Public health: Broader screening and follow-up could catch hypertension earlier.
- Clinical practice: Providers may combine lifestyle counseling with earlier initiation of combination therapy.
- Drug development: Positive trial results for baxdrostat may spur regulatory review and offer a new option for resistant cases.
Official statements
“There’s a really enormous preventive health opportunity in treating hypertension earlier,” said Dr. Jordana Cohen, a nephrologist and hypertension specialist at the University of Pennsylvania.
Dr. Jordana Cohen, University of Pennsylvania
“For all people with a blood pressure over 140/90 mm Hg, we recommend beginning with two medications,” said Dr. Dan Jones, chair of the guideline committee.
Dr. Dan Jones, American Heart Association guideline committee
Unconfirmed
- Long-term effects of baxdrostat on dementia rates are not established; current evidence shows short-term blood pressure lowering only.
- Regulatory approval and an exact timeline for baxdrostat remain pending despite sponsor plans to submit data to authorities by year-end.
Bottom line
Detecting and addressing elevated blood pressure earlier — through diet, exercise, stress reduction and timely use of medications when needed — offers a practical path to reduce strokes, heart attacks and potentially dementia. New therapies such as baxdrostat may help people whose pressure stays high on current regimens, but broader screening and adherence support are essential to realize population benefits.