The next time you get your blood pressure checked, expect your medical provider to be a bit more aggressive about high levels. And if you like a glass of wine with dinner or a cocktail on the weekends, brace yourself: New guidelines from the American Heart Association and the American College of Cardiology released Thursday suggest you abstain.

Committees from the heart organizations continuously assess the latest research so they can help medical providers figure out the best approach to high blood pressure, but this is the first new set of guidelines since 2017. Heart disease has long been the No. 1 killer in the world and blood pressure is one of the most easily modifiable ways to avoid such a death. Keeping your blood pressure in check can also reduce your risk of kidney disease, type 2 diabetes and dementia.

Nearly half of all adults in the U.S. have higher than normal blood pressure. The goal numbers for adults haven’t changed, according to the guidelines: Normal blood pressure is less than 120/80 mm Hg, elevated blood pressure is 120-129/80 mm Hg. If you are at 130/80 mmHg or higher, according to the new guidelines, your medical provider will want you to make some changes.

Blood pressure is measured in millimeters of mercury, which is abbreviated as mm Hg. The measurement has an upper number, or systolic reading, and a lower number, a diastolic reading: Systolic pressure measures the force of blood as it pumps out of the heart into the arteries, and diastolic is the pressure created as the heart rests between beats.

High blood pressure doesn’t have any symptoms typically. But when your blood pressure is high, the force of your blood pushes against the walls of your blood vessels, making your heart less efficient, so both the vessels and heart must work harder. Without treatment, high blood pressure will eventually damage your arteries, raising your risk of having a heart attack or stroke.

How high blood pressure is treated
The new blood pressure guidelines say that if your systolic blood pressure is in the 130 to 139 range, your medical provider should first encourage you to adopt healthy lifestyle changes. After three to six months, if the lifestyle changes alone don’t lower your blood pressure to the goal range, then medication is recommended, the new guidelines say. That’s a shift from 2017 recommendation that anyone with systolic blood pressure above 140 should be prescribed lifestyle changes and medication.

“So just trying to more aggressively control blood pressure, for it to be better for more people, to prevent cardiovascular disease, strokes, kidney disease, and now we know lowering blood pressure actually helps reduce the risk for dementia as well. So that’s really big news out of this guideline,” said Dr. Daniel Jones, American Heart Association chair of the writing committee for the guidelines.

Lifestyle changes, according to the new guidelines, include maintaining or achieving a healthy weight, eating a heart-healthy diet, reducing the amount of salt in what you eat and drink, managing stress, at least 150 minutes of moderate physical activity per week and resistance exercise like weight training.

There’s another shift from 2017: The new guidelines also recommend forgoing alcohol.

The guidelines used to say that if people chose to drink, it should be one drink or less a day for women, and two or less a day for men. Jones said there’s just too much evidence now that alcohol negatively impacts your blood pressure.

“A lot of people enjoy drinking, but because the evidence is there, we want you to make an informed decision,” said Jones, who is also dean and professor emeritus of the University of Mississippi School of Medicine. “There’s a lot of individual variability with the relationship between alcohol and blood pressure, but we put forward the ideal as abstinence, and for those who choose to drink, less than one for women and less than two for men.”

Based on a growing body of evidence, there’s also more emphasis on how important it is to lower blood pressure to reduce the risk of developing dementia, Jones said.

With more studies about women having trouble with high blood pressure during pregnancy, Jones said, the guidelines also newly emphasize how important it is for people who want to become pregnant or those who are pregnant to monitor their blood pressure. High blood pressure can hurt the pregnancy and can raise a person’s risk of having elevated blood pressure even long after pregnancy.

Dietary recommendations still include the DASH diet which is a diet high on fruits, vegetables, whole grains, fish, poultry, beans, nuts, and vegetable oils and and low on fat, sugar, and tropical oils like coconut and palm oils.

“We also harp on sodium again and we know salt and alcohol are favorites for lots of people, but we do recommend limiting salt intake, increasing potassium intake,” Jones said. One easy way to do that is if cooking at home to use potassium-enriched salt substitutes. Sodium intake should be less than 2,300 mg per day, moving toward a more ideal limit of 1,500 mg per day.

For people with overweight or obesity, the guidelines recommend losing at least 5 per cent of body weight. For people with more severe obesity, the guidelines recommend what Jones says are clinically proven interventions: diet and exercise, and weight loss medications including GLP-1s. For people with very severe obesity, the guidelines also suggest surgery.

Jones said he knows it can be difficult for people to keep their blood pressure in check, but taking these steps can help a person’s health significantly.

“The reality is the first line of things we recommend for both prevention and treatment of high blood pressure have to do with eating and we live in a very difficult environment for food. It’s hard for people to have a low sodium intake. It’s hard for people to eat enough potassium. It’s hard for people to take in a small number of calories, but the good news is that all that stuff works if you’re willing to do it,” Jones said. “It’s hard, but it works.”