Blood Pressure Guidelines Move Away From Medication for All Older Americans

For years, turning 65 with a blood pressure reading above 130 meant one thing: medication.

A new analysis of the 2025 American Heart Association guidelines shows that this practice is changing, finding that roughly 10 percent of older adults previously flagged for treatment may no longer meet the criteria, a move experts say prevents overtreatment, but one that carries its own risks.

The 2025 guidelines marked a significant departure from the 2017 AHA guidelines, which recommended treatment for all adults over 65 with blood pressure at or above 130/80 mmHg.

The updated 2025 guidelines replace that blanket approach with one that weighs a patient’s 10-year cardiovascular disease (CVD) risk, offering what experts describe as a more personalized lens on heart health.

Under the new framework, immediate medication is no longer recommended based only on age and blood pressure levels, but also with consideration of the individual’s other cardiovascular risk factors. This translates to around 1 in 10 Americans over the age of 65 with early hypertension who would no longer being recommended medication.

More than 70 million Americans are currently taking medication to lower their blood pressure and reduce their risk of heart attack and stroke. However, these drugs can sometimes cause side effects like dizziness, fatigue, and kidney problems, making the question of who truly needs treatment a consequential one.

Personalized Treatment for Older Adults

Researchers analyzed data from 2,200 adults aged 65 to 79 with high blood pressure. They compared two groups: one that received treatment based on the 2017 guidelines, and another based on the current ones, which are guided by each person’s overall health risk profile.

They found that around 1 in 10 Americans over the age of 65 with Stage 1 hypertension would no longer be recommended medication, provided that they are otherwise healthy with no other cardiovascular risk factors.

Stage 1 hypertension is defined by blood pressure readings of 130 to 139 mmHg systolic or 80 to 89 mmHg diastolic.

The study also found that about 40 percent of older adults with high blood pressure could benefit from treatment that considers their overall health risks, not just their blood pressure numbers. This risk-guided approach could prevent overmedication of patients and thereby shield more patients from the potential side effects of blood pressure medication, while still reducing cardiovascular disease risk.

“The art now is to match the intensity of treatment to both global cardiovascular risk and the patient’s blood pressure, rather than chasing a number at all costs and treating all older patients with a ‘one size fits all’ approach,” Dr. Carolyn Lam, senior consultant cardiologist at the National Heart Center of Singapore and co-founder of AI medtech platform Us2.ai, told The Epoch Times.

In older adults, the concerns with over-aggressive blood pressure lowering include dizziness, falls, fractures, and acute kidney injury, especially in those who are frail or have chronic kidney disease, Lam noted.

The risk-guided approach, she explained, concentrates intensive treatment where the absolute benefit is greatest—typically in patients with diabetes, kidney disease, or multiple cardiometabolic risks—while avoiding unnecessary polypharmacy in lower-risk patients.

“Done well, this can reduce heart attacks, strokes, and heart failure, yet also help preserve independence and quality of life in later years,” Lam said.

Overtreatment vs. Undertreatment

“Many of these people are fragile,” he pointed out, and have blood pressure that goes up and down in a way that can be difficult to predict.

“Some of them have periods where their blood pressures go very low on their own, and then the blood pressure medication is quite difficult to use because you’re trying to abolish the high values, but you don’t want them to be exposed to low [blood pressure] values,” he said.

However, Kowey also warned that the report may have the unintended consequence of reducing treatment for those who really need it.

“I have a big problem with this,” he said. “It’s very analogous to what we’ve done with statins and LDL.”

He compared the new model for prescribing antihypertensive drugs to the risk models applied from previous guidelines on statin prescription statins and LDLs, which reduced the number of Americans that would once be candidates for statin medication by up to 40 percent.

Because the new risk model requires considering all relevant risk factors for treating high blood pressure, Kowey said a primary care doctor who is not savvy enough or doesn’t have enough time to do all the risk assessments is likely to get the wrong message.

“Which is, ‘well, I don’t have to treat this guy or this lady,’ and I think that could be a big trap,” he warned.

Kowey emphasized that he would very much not want primary care doctors to be, in the 10 minutes that they have spent with a patient, “sitting there wringing their hands about whether they should treat a blood pressure of 160 over 100 because of the risk factor issue.”

He concluded that the big challenge isn’t getting people off medications—“The big challenge here is finding all the people out there that need to be treated and giving them something that works, and that they can tolerate.”

Interesting/ . I was taking one bp pill each morning, Lisinipril. Great BP for years.

Suddenly afflicted with Vertigo, serious enough to spend seeral days in best hsopital in town where they put me on a four pills every day including Apixiban, , some in a.m. and some before bed. The also did an MRI, and I did NOT have a stroke. Phew!! Followed by two weeks in a great nursing home where they litrally kept my pills and watched me down them every night. Glad to be home again. Wish I could have brought my Physical Therapist with me. He really pushed me and I can now do more than I could last year.

I’m going to go along with this for another couple of months when weather will be nice enough to get out and walk a mile a day .I hate Big Pharma but love my life. And my bitchy cat needs me. I will be 90 in June. Weigh 112.

I started taking supplements March 2020 to beat COVID. I’ve kept them up and added some more. I take 1 to 5 below. I think my diuretic BP med lowered my potassium so doc put me on the potassium supplement.

Several over-the-counter (OTC) supplements have evidence from meta-analyses, randomized trials, and reviews suggesting they can help lower blood pressure (BP), particularly in people with hypertension or elevated levels. The effects are generally modest (often 2–8 mmHg reduction in systolic BP) and work best alongside lifestyle changes like the DASH diet, exercise, and reduced sodium intake. Results vary by individual, and evidence quality differs.

Important caveats:

These are not substitutes for prescribed medications. Consult a doctor before starting any supplement, especially if you have kidney issues, take medications, or have other health conditions (e.g., potassium supplements can be risky with certain drugs or kidney problems).
Get relevant levels checked via blood tests where appropriate (e.g., magnesium, potassium, vitamin D deficiencies).
Prioritize food sources when possible (e.g., leafy greens, bananas, avocados for magnesium and potassium).

Here are the OTC supplements with the strongest and most consistent evidence for meaningful blood pressure effects, based on multiple meta-analyses and reviews:

Potassium — Frequently cited as one of the most effective. Supplements (or high-potassium diets) reduce systolic BP by approximately 4–5 mmHg on average. It counters sodium’s effects and supports blood vessel relaxation. Evidence is strong from dose-response meta-analyses.
Magnesium (e.g., citrate or glycinate forms) — Reduces systolic BP by ~2–4 mmHg in many studies, especially at doses of 240–400 mg/day taken over weeks or months. It functions as a natural calcium channel blocker and promotes vessel relaxation. Multiple meta-analyses support this, particularly in deficient individuals.
Aged Garlic Extract — Shows consistent reductions (e.g., ~5–9 mmHg systolic in meta-analyses of trials). Likely works via nitric oxide increase, antioxidant effects, and ACE inhibition. Evidence is solid, especially in people with hypertension.
Omega-3 Fatty Acids (fish oil, EPA/DHA) — Can lower BP modestly (~2–5 mmHg at doses of 2–3 g/day), with stronger effects in those with higher baseline BP. Supported by reviews, though results vary at typical OTC doses.
Coenzyme Q10 (CoQ10) — Reduces systolic BP by several mmHg according to meta-analyses. Acts as an antioxidant supporting heart and vessel function; good evidence as an adjunct therapy.
Hibiscus (tea or extract) — Reductions of ~5–10 mmHg in some trials, comparable to certain medications in studies. Has diuretic-like and vessel-relaxing effects.
Beetroot Juice/Extract (high in nitrates) — Converts to nitric oxide, relaxing vessels and lowering BP by ~4–10 mmHg in short-term studies and meta-analyses.

Other supplements with some supporting evidence include Vitamin C, Vitamin D (if deficient), and L-arginine, but the data is less consistent or weaker.

The biggest effects (based on magnitude and consistency across reviews) tend to come from:

Potassium
Magnesium
Aged garlic extract
Hibiscus and beetroot

—often producing 4–8+ mmHg reductions in systolic BP in relevant populations.

Always prioritize professional medical advice, as supplements can interact with medications or cause side effects. Lifestyle changes (diet, exercise, weight management, stress reduction) typically have a larger and more reliable impact than any single supplement.

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