New Guidelines Urge Americans to Reduce Alcohol and Salt for Better Blood Pressure

It’s estimated that over 115 million Americans have high blood pressure. Now, in an effort to address this figure (and the host of dangerous conditions that often accompany high blood pressure), the American Heart Association and the American College of Cardiology have released updated guidelines on how Americans should be managing their heart health.

The new report zeroes in on sodium and alcohol consumption—specifically, for anyone looking to treat or even just prevent high blood pressure (hypertension), the authors now recommend:

• Using potassium-based salt substitutes to cut down on sodium intake
• Avoiding alcohol

The guidelines, published Aug. 14 in Circulation, replace the American Heart Association (AHA) and American College of Cardiology (ACA)’s high blood pressure guidelines from 2017, and place a greater emphasis on prevention and early treatment. These and other lifestyle changes are recommended for all adults.

“These recommendations are key to preventing or reducing the risk of heart disease, stroke, dementia, and chronic kidney disease,” Daniel Jones, MD, chair of the guideline writing committee, past president of the AHA, and dean and professor emeritus at the University of Mississippi School of Medicine, told Health.

To update these guidelines, a committee of experts conducted a seven-month review of relevant hypertension research published since February 2015. In the end, they wanted to come up with a “living, working document” to guide healthcare professionals who treat patients with the condition.

The experts again recommended that people consume less than 2,300 milligrams (mg) of sodium daily, but strive to consume 1,500 mg or less. To achieve that, they recommended the use of potassium-based salt substitutes (as long as a person doesn’t have chronic kidney disease or is using a drug to enhance potassium absorption).

In 2017, the report recommended limiting alcohol consumption to no more than one drink per day for women, and two for men. While that guidance is still included in the updated report, the authors have now taken it a step further, adding that avoiding alcohol altogether is “optimal” for healthy blood pressure.

When someone has hypertension, it means the force of blood flowing through their blood vessels is higher than it should be. And alcohol and sodium consumption can both contribute to that elevated pressure.

According to the AHA, eating too much salt both increases the amount of blood being pumped through the body and constricts the blood vessels over time. The majority of Americans’ sodium intake comes from restaurant meals or processed foods.

When it comes to alcohol, the mechanisms are a little less clear. Experts have suggested that alcohol consumption could cause inflammation, increased cortisol levels, or imbalances of the central nervous system, among other factors, all of which may increase blood pressure.

The amount consumed does matter—heavier drinking has been linked to hypertension, as well as cardiomyopathy, heart disease, and issues with the blood itself. However, even small amounts of daily alcohol consumption can raise blood pressure, a 2023 study found.

Whether from salt, alcohol, or something else, this added pressure on your blood vessels can take a toll on your health long term. Hypertension is the most prevalent and modifiable risk factor for the development of cardiovascular diseases such as coronary artery disease, heart failure, atrial fibrillation, stroke, chronic kid­ney disease, and all-cause mortality, Jones explained.

Brain health is also a concern: “Blood pressure affects cognitive function and [can lead to] dementia,” Paul Bhella, MD, cardiologist and professor of medicine at the Burnett School of Medicine at Texas Christian University, told Health.

Specifically, research has shown that having hypertension in middle age is linked to about a 60% greater risk of dementia and roughly a 25% higher Alzheimer’s disease risk.

So by treating high blood pressure—or preventing it in the first place—healthcare providers can lower their patients’ risk of these chronic conditions. And per the new guidelines, they may recommend changes to your lifestyle and diet sooner than they might have in the past.

Beyond just salt and alcohol consumption, the committee also suggested people utilize the AHA’s PREVENT tool, which helps people ages 30 to 79 estimate their 10- and 30-year risk for cardiovascular disease (CVD), Jones said.

To do this, PREVENT looks at body mass index, blood pressure, social drivers of health, and other factors, he explained. If a person’s score is elevated, they should start medication to lower their blood pressure, even if they haven’t quite reached Stage 2 hypertension, according to the new guidelines.

“In medicine, we can’t take a one-size-fits-all approach,” Omar Obaid, DO, cardiologist at Rush University Medical Center, told Health. “The PREVENT calculator helps you and your provider identify your individual risk for the development of heart and vascular disease, so that they can tailor treatment to you.”

Additionally, the new report made additional recommendations to manage blood pressure in special populations:

• For those who are pregnant: If someone has chronic hypertension (not solely related to their pregnancy), the new report recommends that they should be treated. Trials have shown taking medication at a blood pressure of 140/90 mmHg—rather than waiting until the previous target of 160/105 mmHg—leads to better pregnancy outcomes, Wanpen Vongpatanasin, MD, one of the guideline committee members and director of the hypertension fellowship program at UT Southwestern, told Health.
• For those with uncontrolled high blood pressure: Some people with severe hypertension are at high risk of heart attack, stroke, or other cardiovascular issues, said Raymond Townsend, MD, director of hypertension in the department of internal medicine/renal at the University of Pennsylvania School of Medicine. Only after discussion with experts and consideration of other options, the new guidelines recommend renal denervation—a procedure that tamps down nerves in the kidney—for these patients. This strategy “reinforces the importance of tailoring care to those most vulnerable to cardiovascular events, and provides clinicians with another tool to help lower risk,” Townsend told Health.

Managing your blood pressure can seem daunting—especially when it means making major cuts to your sodium and alcohol intake. But experts agree these two changes can help reduce your risk of heart issues and dementia later in life.

To implement these guidelines, according to Townsend, you can:

• Limit packaged or processed foods, particularly those with high sodium content
• Follow the DASH diet
• Choose whole foods and fresh ingredients whenever possible
• Drink flavored sparkling water, teas, or mocktails to reduce alcohol consumption

Other helpful tips for managing or preventing hypertension? Make sure you exercise regularly, lower your stress levels, quit smoking, and get as much high-quality sleep as possible.

Alongside lifestyle changes and medication, it can also be smart to check your blood pressure regularly at home if you have hypertension, per the new report. “It can help confirm a diagnosis, avoid false readings caused by nervousness at the doctor’s office (known as the ‘white-coat’ effect), and track how well your treatment is working over time,” Obaid explained.

You can find a list of accurate blood pressure monitors at validatebp.org, a site endorsed by the American Medical Association, Vongpatanasin suggested. If you see your readings trending upward, that might be a sign to contact your doctor.

At the end of the day, though, even when you’re doing everything right, “hypertension can be hard to control,” Townsend emphasized. “The good news is, these updated guidelines give patients and physicians more options to treat hypertension.”