New blood pressure guidelines and how exercise helps lower blood pressure
Medically reviewed by Leo Kao, MD
Board-certified internal medicine physician
Nearly half of American adults have high blood pressure, and many don't know it. In 2025, the American Heart Association (AHA) and American College of Cardiology (ACC) released their first major update to blood pressure guidance since 2017. Here's what changed, what your numbers mean, and how regular exercise, one of the most effective tools you have outside the pharmacy, can help bring them down.
Key takeaways
- Normal is below 120/80. High blood pressure starts at 130/80 mm Hg.
- For most adults with high blood pressure, the goal is below 130/80, with encouragement to work toward a top number under 120.
- Home monitoring with a validated upper-arm cuff is recommended. Smartwatches and other cuffless devices are not recommended for diagnosis or management.
- Lifestyle comes first at every stage: less sodium, a heart-healthy diet, little or no alcohol, a healthy weight, stress management, and regular exercise.
- Aerobic, strength, combined, interval, and isometric training all lower resting blood pressure. Isometric exercise, such as wall sits, showed the largest average drop in a major 2023 analysis.
Blood pressure categories for adults
Blood pressure is written as two numbers. The top (systolic) number is the pressure in your arteries when your heart beats. The bottom (diastolic) number is the pressure between beats. The 2025 guideline kept the categories introduced in 2017:
| Category | Top number (systolic) | Bottom number (diastolic) | |
|---|---|---|---|
| Normal | Less than 120 | and | Less than 80 |
| Elevated | 120–129 | and | Less than 80 |
| Stage 1 hypertension | 130–139 | or | 80–89 |
| Stage 2 hypertension | 140 or higher | or | 90 or higher |
| Severe hypertension | Higher than 180 | and/or | Higher than 120 |
A diagnosis is based on the average of several readings taken on different occasions, not a single number. Only a licensed clinician can diagnose high blood pressure.
If a reading is above 180/120: rest a few minutes and recheck. If it's still that high and you have chest pain, shortness of breath, back pain, numbness or weakness, vision changes, confusion, or trouble speaking, call 911. If you feel fine, contact your physician promptly.
What's new in the 2025 guidelines
The guideline was published jointly by the AHA, the ACC, and more than a dozen partner organizations, and replaces the 2017 version. Its focus is finding and treating high blood pressure earlier to protect the heart, kidneys, and brain. The changes most relevant to patients:
- Earlier action. Lifestyle changes start as soon as blood pressure rises, and medication may be considered sooner for people at higher cardiovascular risk.
- A lower target. For most treated adults, the goal is below 130/80, with encouragement to aim for a top number under 120 when appropriate.
- Home monitoring. Patients who are willing are encouraged to check their blood pressure at home to confirm a diagnosis and follow progress.
- A new risk calculator. Clinicians now use the AHA's PREVENT calculator to estimate 10-year cardiovascular risk and guide treatment decisions.
- Brain health. Stronger evidence links well-controlled blood pressure with a lower risk of cognitive decline and dementia.
- Alcohol. Less is better. Ideally, don't drink; if you do, keep it to a minimum.
- Diet. Cutting sodium and following a DASH-style eating pattern remain core recommendations, and potassium-based salt substitutes are endorsed for some people.
A caution about salt substitutes: potassium-based salt substitutes aren't safe for everyone. People with kidney disease, or who take certain blood pressure or heart medications such as ACE inhibitors, ARBs, or potassium-sparing diuretics, can develop dangerously high potassium levels. Ask your physician before using one.
How exercise affects blood pressure
Exercise works on blood pressure in several ways:
- Right after a workout, blood pressure often dips below its usual level for several hours. This is called post-exercise hypotension.
- Over weeks to months, regular activity helps blood vessels relax and widen more easily, may reduce arterial stiffness, and quiets the "fight-or-flight" nervous system signals that push blood pressure up.
- Indirectly, exercise supports a healthy weight, better blood sugar, better sleep, and lower stress, all of which affect blood pressure.
It's normal for blood pressure to rise during exercise. That temporary increase is your body meeting the demand of activity. The benefit shows up in your resting blood pressure over time.
Which type of exercise lowers blood pressure the most?
A large 2023 analysis in the British Journal of Sports Medicine pooled 270 clinical trials with nearly 16,000 participants and compared types of exercise training. Every type studied lowered resting blood pressure. The average reductions were:
| Exercise type | Examples | Average drop (mm Hg) |
|---|---|---|
| Isometric | Wall sit, handgrip squeeze, plank | 8.2 / 4.0 |
| Combined | Aerobic plus strength, such as a brisk walk and light weights | 6.0 / 2.5 |
| Dynamic resistance | Weights, bands, body-weight squats | 4.6 / 3.0 |
| Aerobic | Walking, cycling, swimming, pickleball | 4.5 / 2.5 |
| High-intensity intervals (HIIT) | Short bursts of hard effort with recovery | 4.1 / 2.5 |
Figures are averages across study participants. Individual results vary.
A drop of even 5 points in the top number is meaningful for heart attack and stroke risk. The best exercise is the one you can do safely and keep doing. For many people that's a mix: regular aerobic activity for overall heart health, strength training (see our article on why strength training belongs in your health plan), and, with your physician's approval, short isometric sessions. If you want a baseline for your fitness, VO2 max testing can help set the right intensity.
A safe way to get started
The American Heart Association recommends at least 150 minutes a week of moderate-intensity activity for most adults, plus muscle strengthening on at least two days. "Moderate" means you can talk but not sing. Here's one example of how a week could look once you're cleared to exercise:
- Mon30-minute brisk walk
- TueStrength: bands or light weights, 20 minutes
- Wed30-minute bike ride or swim
- ThuIsometric session* and stretching
- Fri30-minute walk or pickleball
- SatStrength plus a 20-minute walk
- SunRest or an easy stroll
*Only with your physician's approval. This is a general example, not a personal exercise prescription.
Tips that help:
- Start low, go slow. If you've been inactive, begin with 10-minute walks and build up gradually.
- Warm up and cool down for 5 to 10 minutes so your heart rate and blood pressure can adjust.
- Breathe steadily. Never hold your breath while lifting or holding a position. Breath-holding can spike blood pressure.
- Respect the Florida heat. Exercise early in the morning, in the evening, or indoors, and stay hydrated. Some blood pressure medicines affect how your body handles heat and fluids.
- Stay consistent. The blood pressure benefit fades within weeks if you stop.
Exercise safety and warning signs
Talk with your physician before starting a new exercise program, especially if you:
- Have high blood pressure that isn't yet controlled, or readings at or above 160/100
- Have heart disease, a heart rhythm problem, a prior stroke, kidney disease, or diabetes
- Take medications such as beta-blockers, which change how your heart rate responds to exercise
- Are pregnant, have recently had surgery, or have eye disease such as retinopathy
- Have been inactive for a long time
Stop exercising and get help if you have chest pain or pressure, unusual shortness of breath, dizziness or fainting, a racing or irregular heartbeat, or pain spreading to your arm, jaw, or back. Call 911 if symptoms are severe or don't go away with rest.
Don't stop or change a prescribed blood pressure medication on your own because you've started exercising. Your physician can adjust treatment as your numbers improve.
How to check your blood pressure at home
Home readings show the real picture, and they let you see the progress your exercise routine is making. For accurate results:
- Use a validated upper-arm cuff that fits your arm. You can check a device at validatebp.org. Avoid wrist devices and smartwatches for tracking.
- Avoid caffeine, exercise, and smoking for 30 minutes beforehand, and empty your bladder.
- Sit quietly for 5 minutes with your back supported, feet flat, and legs uncrossed.
- Rest your arm on a table at heart level, with the cuff on bare skin.
- Take 2 readings, 1 minute apart, in the morning and evening, and keep a log.
- Bring your log or your device to your appointments.
Blood pressure care at Lakewood Ranch Concierge
Checking and managing blood pressure is a routine part of primary care, and our membership gives you direct access to Dr. Kao by phone, text, or portal. That means you can send home readings between visits and talk through an exercise plan before you start, instead of waiting months for the next appointment. See our services, text us to request an appointment, or call (941) 237-0129.
Frequently asked questions
What is considered normal blood pressure under the new guidelines?
Under the 2025 AHA/ACC guideline, normal blood pressure is below 120/80 mm Hg, and high blood pressure (hypertension) begins at 130/80 mm Hg. A diagnosis is based on several readings taken on different occasions, not a single number, and your physician interprets your numbers in the context of your overall health.
How much exercise do I need to help lower my blood pressure?
The American Heart Association recommends at least 150 minutes a week of moderate-intensity activity for most adults, plus muscle strengthening on at least two days. Aerobic, strength, combined, interval, and isometric training have all been shown to lower resting blood pressure. Check with your physician before starting a new program.
Are wall sits safe if I have high blood pressure?
Isometric exercises such as wall sits can lower resting blood pressure over time, but blood pressure rises temporarily while you hold the position. If your blood pressure is not yet controlled, or you have heart disease, eye disease such as retinopathy, or another serious condition, get medical clearance first. Breathe steadily and never hold your breath.
Can I use my smartwatch to check my blood pressure?
The 2025 guideline does not recommend cuffless devices, including smartwatches, for diagnosing or managing high blood pressure because of accuracy concerns. A validated upper-arm cuff is the preferred device for home monitoring.
If exercise lowers my blood pressure, can I stop my medication?
Do not stop or change a prescribed blood pressure medication on your own. Many people need both lifestyle changes and medication. As your home readings improve, your physician can decide whether and how to adjust your treatment.
References
- Jones DW, Ferdinand KC, et al. 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults. Hypertension. 2025;82(10):e212–e316. doi:10.1161/HYP.0000000000000249
- American Heart Association. New high blood pressure guideline focuses on prevention and early treatment. heart.org
- Edwards JJ, Deenmamode AHP, Griffiths M, et al. Exercise training and resting blood pressure: a large-scale pairwise and network meta-analysis of randomised controlled trials. Br J Sports Med. 2023;57:1317–1326. doi:10.1136/bjsports-2022-106503
This article is for general educational purposes only and is not a substitute for personal medical advice, diagnosis, or treatment. Reading it, or contacting the office by phone, text, or email, does not create a physician–patient relationship with Leo Kao, MD, or Lakewood Ranch Concierge. Blood pressure targets and treatment are individualized; what is right for you can only be decided after an individual evaluation.
Exercise carries inherent risks, including injury, cardiac events, and changes in blood pressure. The exercise examples above are general illustrations, not individualized recommendations. Talk with your physician before starting any exercise program, changing your diet, or using salt substitutes or supplements, and do not start, stop, or change any medication without your physician's direction. Research findings describe average results in study groups; individual results vary, and no specific outcome is guaranteed.
This information reflects published guidance available as of the date above and may change as new evidence emerges. Links to outside websites are provided for convenience and do not imply endorsement. Please do not send personal health information through standard email or text unless the office has directed you to a secure method. For a medical emergency, call 911 or go to the nearest emergency room.