Heart to heart: New blood pressure guidelines

In November 1982, Kenny Loggins released the song "Heart to Heart," which he co-wrote with Michael McDonald of Doobie Brothers fame. The team of Loggins and McDonald were known for such hits as "What a Fool Believes" and "This Is It." Loggins is famous for his various film soundtracks including "Footloose," "Caddyshack," and "Top Gun." Loggins produced 7 albums with his music partner, Jim Messina. The meaning behind Heart to Heart is to keep hearts open when trying to preserve a relationship when it feels as though you have grown apart. New blood pressure (BP) guidelines may help us keep our hearts open and healthy. It has been 8 years since new blood pressure (hypertension) guidelines have been published. In 2025, the American Heart Association with the American College of Cardiology released their Multisociety Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults. These guidelines were developed by leading heart specialists based on published science and high levels of evidence. One of the first recommendations is to have a BP treatment goal of a systolic BP less than 130 mm Hg and a diastolic BP less than 80. However, individuals with an increased risk of a cardiovascular or heart disease should attempt to achieve a BP below 120/80. How does one know if their heart risk is increased? This has changed with the new guidelines as well. Currently, we can calculate if someone has a higher heart risk by using an ASCVD calculator. The new recommendations use an equation called PREVENT for estimating risk. The PREVENT calculator can be applied to those ages 30 to 79 years and includes several cardiometabolic markers. In addition, the PREVENT equation asks for ZIP code to take into consideration health inequities. The equation provides both a 10-year and 30-year risk. The guidelines indicate lower-risk patients with BP greater than 130/80 should be started on lifestyle modifications for the first 3-6 months before adding medication. Those at higher risk with heart disease, diabetes, or chronic kidney disease should be started on medications and lifestyle changes. When determining high blood pressure, the recommendation is to use a validated BP cuff with 2 healthcare provider readings at 2 separate visits. Good quality BP home devices can be helpful in confirming BP readings from the office visits. The guidelines specifically state that cuffless devices including smartwatches are not a reliable source for BP readings. An out of the healthcare professional office reading can be valuable if someone suffers from white coat hypertension. White coat hypertension is when a person's BP is elevated in the office, but home BP machines find normal results. Some people get anxious or nervous in the office and can have high results. The new guidelines recommend rigorous lifestyle approaches to BP management for all patients with high BP. These include reducing salt intake, weight loss, high-potassium diets, stop use of alcohol, and exercise regularly (150 minutes a week of moderate intensity or 75 minutes per week of vigorous intensity). Another recommendation is to reduce stress. The new recommendations include the topic of healthy cardiovascular aging. It provides the more recent evidence of controlling BP in older adults. Besides the heart advantages, the other benefits of controlling BP to a goal of less than 130/80 in older adults has shown to help prevent or slow cognitive decline and dementia. Another important concept in the new guidelines is to use a team-based approach to heart care. The experts emphasize the importance of physicians, advanced practice providers, nurses, pharmacists, and community health workers in detecting and managing high BP. Our heart to your heart, keep it open and healthy! Karen Kier is a pharmacist with Ohio Northern University HealthWise Pharmacy.