High blood pressure remains one of the most pressing problems in modern healthcare. More than 40 million Russians already live with this diagnosis. Although hypertension often has no noticeable symptoms, it remains a key risk factor for stroke, heart attack, heart failure, chronic kidney disease, and even dementia.

The AHA and the American College of Cardiology (ACC) released updated guidelines on prevention and treatment in August 2024. These new standards replace the 2017 version and emphasize early intervention, lifestyle modification, and an individualized approach to therapy.

What has changed: key points of the new report

The authors of the document spent seven months analyzing the latest studies published since 2015 and concluded that effective management of hypertension requires focusing on two key factors — salt and alcohol consumption.

The recommendations include:

• reducing sodium intake to 2,300 mg per day (with an optimal target of 1,500 mg or lower);
• using potassium-based salt substitutes (if no contraindications are present);
• complete avoidance of alcohol as the optimal strategy for blood pressure control.

Importantly, the updated guidelines address not only the treatment but also the prevention of hypertension, as well as the protection of the brain and cognitive functions.

How salt increases blood pressure

Salt (sodium chloride) plays an important role in regulating fluid balance and the functioning of the nervous system. However, excessive salt intake leads to fluid retention in the body and an increase in blood volume. As a result, the pressure on the vessel walls rises.

Over time, a number of changes develop:

• blood vessels lose their elasticity;
• chronic vascular spasm develops;
• the workload on the heart increases;
• the risk of atherosclerosis increases.

According to the AHA, the main source of salt is not the salt shaker at home. About 70% of sodium comes from processed and prepackaged foods such as bread, sausages, cheese, canned goods, fast food, and restaurant meals. Therefore, even people who “don’t add extra salt” often consume two to three times the recommended amount.

The use of potassium-based salt substitutes has proven effective. Studies show that such alternatives not only lower blood pressure but also reduce the risk of stroke and cardiovascular mortality. However, in cases of chronic kidney disease or when taking medications that increase potassium levels, these substitutes can be dangerous.

Alcohol and hypertension: even small amounts matter

Alcohol was long considered “acceptable” in moderate amounts. The 2017 guidelines stated that women could have one drink per day and men two. However, new data have changed this view.

It is now proven that:

• even small daily amounts of alcohol raise blood pressure;
• regular consumption leads to vascular inflammation, increased cortisol levels, and impaired nervous system function;
• chronic alcohol abuse is associated with hypertension, cardiomyopathy, arrhythmias, and stroke.

In 2023, a large study showed that there is no “safe dose” of alcohol for blood pressure. Even one glass of wine per day can gradually increase the risks. Therefore, the new guidelines are clear: complete abstinence is optimal.

Why it is important to monitor blood pressure

High blood pressure is often called the “silent killer.” It often develops without symptoms but slowly damages the heart, blood vessels, and brain.

Main complications of hypertension:

• coronary artery disease and myocardial infarction;
• хроническая сердечная недостаточност;
• stroke and transient ischemic attacks;
• chronic kidney disease;
• atrial fibrillation.

Special attention is given to cognitive health. Studies show that having hypertension in middle age increases the risk of dementia by 60% and the risk of Alzheimer’s disease by 25%. Thus, controlling blood pressure is not only about protecting the heart but also about preserving memory and thinking.

Individual prevention: the PREVENT calculator

The new guidelines recommend using a calculator PREVENTthat allows for the assessment of cardiovascular risk over 10 and 30 years.

It takes into account:

• blood pressure;
• body mass index;
• level of physical activity;
• social and behavioral factors (stress, smoking, diet).

If a high risk is detected, the doctor may recommend early initiation of medication even if the patient does not yet have significant hypertension. This approach helps prevent complications before the disease becomes apparent.

Special patient groups

Pregnant women

For pregnant women with chronic hypertension, it is now recommended to start therapy at 140/90 mmHg rather than waiting for it to rise to 160/105 mmHg. This approach helps reduce the risk of complications for both mother and baby.

Patients with severe hypertension

For people with uncontrolled blood pressure, a method is being considered renal denervation. This is a minimally invasive procedure that blocks the nerves involved in blood pressure regulation. The technique remains a “reserve” option and is used only after other approaches have been exhausted.

Lifestyle against hypertension

In addition to salt and alcohol, the recommendations include a wide range of measures:

• The DASH diet — a diet rich in vegetables, fruits, whole grains, fish, and lean meats, while minimizing processed foods.
• Physical activity — at least 150 minutes of moderate aerobic exercise per week.
• Smoking cessation — tobacco increases vascular spasm and accelerates atherosclerosis.
• Weight control — even a 5–10% weight reduction lowers blood pressure.
• Stress management — breathing exercises, yoga, psychotherapy.
• Healthy sleep — regular and adequate rest reduces stress hormone levels.

Even simple steps — replacing sugary drinks with water, avoiding fast food, and taking walks after work — help normalize blood pressure in the long term.

Self-monitoring: home measurements

Home blood pressure monitoring is an important part of therapy. It allows you to:

• detect the “white coat effect,” when readings are higher only in the doctor’s office;
• track the effectiveness of treatment;
• notice an upward trend before complications occur.

The American Medical Association recommends choosing blood pressure monitors from the list at validatebp.org — it features verified and accurate models.

Why hypertension is difficult to control

Even when all recommendations are followed, blood pressure sometimes remains elevated. This may be due to genetic factors, age-related vascular changes, or accompanying diseases. However, it is important to understand that every step, even a small one, helps reduce the risk of complications.

Modern approaches make it possible to combine non-drug measures, medications, and new technologies. This gives patients more opportunities to maintain heart and brain health for many years.

Conclusion

High blood pressure — is not just a diagnosis but a global health issue. The new American Heart Association guidelines emphasize that managing risk factors is both possible and necessary: reduce salt intake, avoid alcohol, maintain a healthy weight, and improve sleep and physical activity.

Early prevention and a personalized approach using the PREVENT calculator can help reduce the burden of cardiovascular disease, stroke, and dementia. Home blood pressure monitoring and regular visits to the doctor make it possible to stay in control and adjust therapy in time.

Today, everyone has a chance to live longer and better — if they take this “silent but dangerous” disease seriously.