It's important to monitor your blood pressure at any age, but especially if you're an older adult. When your average blood pressure is higher than normal, it can lead to serious health complications.
"The issue with blood pressure is that it's a silent killer," says Solomon Bienstock, MD, a cardiologist at Mount Sinai Fuster Heart Hospital in New York City. "Most of the time, when your blood pressure is high, you don't feel it at all."
Blood pressure is the force of your blood as it's pumped by your heart and moves through your arteries. It's measured as two numbers. The top or first number, called systolic pressure, is the force when your heart squeezes to push blood out. The bottom or second number, called diastolic pressure, is the force when your heart rests between beats.
Even if you do everything right and feel well, your blood pressure is likely to increase with age. That's because the walls of your arteries tend to harden over time. That's a main reason why older people are at more risk for high blood pressure compared to people who are younger. While it's natural to have higher blood pressure as you age, Bienstock says it comes with more risk for a range of cardiovascular-related problems. Those include:
- Coronary artery disease
- Heart failure
- Atrial fibrillation
- Stroke
- Cognitive decline or dementia
- Chronic kidney disease
High blood pressure is extremely common. The good news is that you can reduce your blood pressure with healthy lifestyle changes, medicines, or a combination of the two.
How Do the New Guidelines Affect Me?
The American College of Cardiology (ACC) and the American Heart Association (AHA) updated national blood pressure guidelines in 2025. Doctors use them to make decisions about how to diagnose and treat high blood pressure.
The latest guidelines don't change what it means for your blood pressure to be high. Normal blood pressure is anything under 120/80. High blood pressure is defined as anything above 130/80. When your systolic pressure is 130 to 139, it's called stage 1 hypertension. If your systolic pressure reaches 140 or higher, it's called stage 2 hypertension.
Compared to previous guidelines, the new one encourage earlier intervention to lower blood pressure. They also emphasize the importance of reducing blood pressure to make dementia less likely along with heart attack, stroke, and heart failure. Louise Walter, MD, a geriatrician at the University of California, San Francisco, says the new guidelines mean she more often aims for a blood pressure under 130/80 for her older patients even if they are otherwise healthy. The first step is to focus on health habits.
"The approach to lowering blood pressure should always start with lifestyle changes, including moderate physical activity, healthy weight, heart-healthy eating, reducing sodium intake, and reducing or eliminating alcohol intake," Walter says. "This advice has not changed and should be encouraged for all adults."
Your doctor may also recommend you start taking medicines to lower your blood pressure. According to the guidelines, the specific recommendations for you will depend on how high your blood pressure is and whether you're able to lower your blood pressure through healthy lifestyle changes. It will also depend on your health and estimated risk for having a cardiovascular event in the future.
Monitoring blood pressure at home
The new guidelines also recommend having a system to test your blood pressure at home. Usually, you can find a good blood pressure monitor for under $100, and some insurance providers will help you pay for them.
Bienstock recommends measuring your blood pressure at home every day. He says it's best to measure it twice in a row to be sure you're getting a good reading. Because you might be anxious about your blood pressure readings, your first reading might be higher. You shouldn't be surprised if your measures at home are lower than they are when you go to see your cardiologist or another doctor. The worry or anxiety that you may feel at the doctor can lead to higher blood pressure readings.
When you buy a blood pressure monitor, make sure it:
- Fits around your upper arm
- Has an automated monitor, and that the cuff inflates itself
- Contains a digital screen big enough for you to read your results
Other tips for getting a good reading include:
- Avoid caffeine and exercise 30 minutes before you take a reading.
- Take off any clothing that would cover your arm.
- Sit still for at least 5 minutes before taking your blood pressure.
Ask your doctor how often you should monitor your blood pressure and what should trigger a call or office visit. You may need to monitor your blood pressure more closely if you have other risk factors or health conditions.
Do the Guidelines Recommend I Do Anything Differently?
Yes, if you're not already following a healthy lifestyle. The latest blood pressure guidelines recommend all adults take healthy steps to prevent or treat high blood pressure.
These include:
- Maintaining or reaching a healthy weight
- Eating a healthy diet, such as the DASH diet, which includes lots of vegetables, fruits, whole grains, beans, nuts, seeds, low-fat or nonfat dairy, plus lean meats, poultry, and fish
- Reducing the amount of salt in your diet to less than 2,300 milligrams per day (less than 1,500 milligrams is even better)
- Increasing the amount of potassium in your diet
- Exercising at least 75 to 150 minutes per week, including cardio and resistance training
- Managing stress with exercise or techniques such as meditation, breathing exercises, or yoga
- Not drinking alcohol or drinking two drinks for men per day and one for women at most
Daniel W. Jones, MD, dean and professor emeritus of the University of Mississippi School of Medicine in Jackson, Mississippi, and chair of the 2025 blood pressure guideline committee, says many older adults can improve or control blood pressure by making these healthy lifestyle changes.
If your blood pressure is 140/90 or higher, the 2025 guidelines recommend you start taking blood pressure-lowering medicine. You should also take medicine to lower your blood pressure if your blood pressure is 130/80 or higher and you also have:
- Cardiovascular disease
- Had a stroke
- Diabetes
- Chronic kidney disease
- Increased 10-year predicted cardiovascular risk of 7.5% or higher based on an online calculator called PREVENT (Predicting Risk of CVS Events), which estimates your risk for a heart attack, stroke, or heart failure
The PREVENT risk calculator includes your:
- Age
- Sex
- Blood pressure
- Cholesterol levels
- ZIP code
PREVENT also combines measures of your cardiovascular, kidney, and metabolic health. Jones says use of the PREVENT risk calculator to make treatment recommendations can mean changes for some older adults.
"Some older adults with a systolic blood pressure 130 to 139 may have a lower risk score than using the old equation," Jones says. "If the risk score is less than 7.5%, the recommendation is lifestyle [change] only for three to six months. But if systolic blood pressure is not controlled to less than 130 after three to six months, medication should be started."
The guidelines recommend medication to control blood pressure for all adults with stage 2 hypertension, or a blood pressure of 140/90 or higher.
Treating High Blood Pressure for Older Adults
Many factors like your age, gender (men are far more likely to have high blood pressure than women), family history, and even race play a role in high blood pressure and its associated risks. But anyone can get high blood pressure, especially as you age. If you're concerned about your high blood pressure, talk to your doctor about treatment options. There are six major types of blood pressure medications including:
- Diuretics
- Beta-blockers
- Vasodilators
- ACE inhibitors
- ARBs (angiotensin II receptor blockers)
- Calcium-channel blockers
You may need more than one medicine to get your blood pressure under 130/80. Your doctor will monitor your blood pressure to see if you need a higher dose or to add another medicine. If your blood pressure is 140/90 or higher, the guidelines recommend starting with two medicines in a combination pill. You may also benefit from taking other medicines to help if you're overweight or have obesity.
As always, be sure to monitor your blood pressure regularly and seek medical care if you notice anything irregular.
Walter notes that the PREVENT calculator equations haven't been validated for use in adults over age 79. If you're 80 or older, talk to your doctor about what this means for you. She says it's also important to take personal preferences or other factors into account to tailor your treatment plan. For instance, some older people may feel dizzy when blood pressure is low, which can increase your risk for falls.
Blood pressure and your brain
Though high blood pressure is a major cause of heart attack and stroke, those aren't the only risks. Studies have shown your blood pressure affects the health of your brain, too.
"The new guidelines specifically place greater emphasis on the relationship between hypertension and brain health," Bienstock says. "Chronic high blood pressures can damage small cerebral blood vessels, and it's associated with cognitive impairment and dementia."
"There should be greater public awareness of the cognitive benefits inherent with a lower blood pressure," Walter says.
Updated guidelines recommend relying on a team to manage your blood pressure, including your doctors and pharmacists. If you have high blood pressure and mild cognitive impairment or dementia, it's especially important to make sure you're taking the right blood pressure medicines as prescribed. It's easiest to remember a once-a-day medicine you can take at the same time daily. Pharmacists can also put your medications in a weekly pillbox that makes it easier to remember to take them correctly.
