High blood pressure is known as a “silent killer” because it can go unnoticed for years while damaging blood vessels and vital organs — and that includes the brain, as well as the heart.
“What’s good for the heart is good for the brain,” says Akash Ghai, MD, cardiologist on the medical staff at Methodist Charlton Medical Center. “There’s emerging evidence that untreated hypertension in your 40s and 50s increases the risk of cognitive decline in your 70s.”
New guidelines released in 2025 by the American Heart Association place a renewed emphasis on that heart-mind connection, as well as early intervention by establishing a lower level for Stage 1 hypertension (130/80 mmHg).
“Studies show that approximately 1 in 5 adults with hypertension are unaware they have the condition,” says Syeda Taliya Rizvi, MD, internal medicine physician on the medical staff at Methodist Celina Medical Center. “Knowing your blood pressure numbers — and addressing them early — is one of the most powerful steps you can take to protect your long-term health,” Dr. Rizvi says.
She and Dr. Ghai explain the new guidelines, why we can’t rely on symptoms to warn us, and how we can take our heart (and brain) health into our own hands.
HOW GUIDELINES CHANGED
Blood pressure is the force with which blood flows through blood vessels to the heart and other parts of the body.
A normal blood pressure reading is below 120 for systolic (the upper number) and below 80 for diastolic (the lower number). If one or both numbers are higher than normal, it means your heart is having to work harder than it should to pump blood through your body.
Beyond setting a lower “universal target” of 120/80 mmHg, the latest guidelines shorten the window for controlling blood pressure with lifestyle changes alone to three to six months, encouraging doctors to turn to medical therapy sooner.
“If diet and exercise is not effective in lowering blood pressure, we should start at least one medication, according to those new guidelines” Dr. Ghai says.
Dr. Ghai also noted the new focus on cognitive decline as an eventual effect of years of untreated hypertension. That risk is proving to be an effective motivator for some patients.
“The guidelines are trying to help motivate people to get their blood pressure under control,” Dr. Ghai says. “There are some patients who are less worried about a heart attack but are more worried about getting dementia and losing their memory.”
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DON’T RELY ON SYMPTOMS
While hypertension can cause chest pain and shortness of breath, doctors don’t typically judge it based on symptoms because by then it may be too late.
“Symptoms should never be relied upon as a way to know your blood pressure is elevated,” Dr. Rizvi says. “Chest pain, shortness of breath, and confusion usually occur only when blood pressure becomes dangerously high and may signal a medical emergency.”
That’s why it’s so critical to identify high blood pressure well before it reaches that stage.
Not long ago, getting your blood pressure checked required a trip to the doctor or the pharmacy to strap into a do-it-yourself machine. That’s no longer the case with the proliferation of affordable monitoring devices that can be used at home.
KEEPING TABS AT HOME
Doctors have long understood the limitations of checking blood pressure at a single point in time, especially if that moment is at a clinic when a patient is already under the weather.
“Some individuals experience ‘white coat hypertension,’ meaning their readings are elevated in a medical setting due to stress or anxiety,” Dr. Rizvi says. “Others may have ‘masked hypertension,’ where blood pressure appears normal in the clinic but is elevated at home.”
She suggests monitoring your blood pressure at home to provide a more realistic picture of day-to-day patterns, recommending an upper-arm cuff that’s been validated for accuracy by the American Medical Association.
“Home blood pressure monitoring is increasingly recommended as an important tool to confirm diagnoses,” Dr. Rizvi says. “In short, checking your blood pressure at home — using a validated upper-arm device and proper technique — is one of the most practical and empowering ways to take control of your cardiovascular health.”
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