At or above 130/80? (In this group the treatment threshold is the goal, so being above goal means yes.) Yes
lower-threshold-metFewer than 5 people have reached this rule so farStart or intensify medication
No clinician has signed off this rule yet. It reflects our reading of the guidelines cited below, which has not been independently checked.
Word for word, as generated for the example person below. Figures in the text are theirs.
Your reading is above goal on your current medication — this is a reason to discuss intensifying or adding a second agent with your doctor.
Expert guidelinesOfficial guidelines recommend it, based on trials plus expert judgment.
Your reading (142/86 mmHg) is at or above 130/80 mmHg, the lower drug-therapy threshold that applies because of diabetes, known CVD, reduced kidney function, or an elevated 10-year risk estimate.
ACC/AHA (US)
Graded for adults with clinical cardiovascular disease, or with diabetes, CKD or a 10-year PREVENT-CVD risk of 7.5% or more, at a systolic pressure of 130 or higher.
2025 AHA/ACC Guideline for the Prevention, Detection, Evaluation and… · Recommendation behind this rule · class and level read from the guideline tables on 2026-09-30
Starting medication when diastolic pressure is 80 or higher, in this group
2025 AHA/ACC Guideline for the Prevention, Detection, Evaluation and… · Graded separately within the same recommendation · class and level read from the guideline tables on 2026-09-30
2025 AHA/ACC Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults · Class 1 · Level A
Before acting on this: one reading isn't a diagnosis. Check it at home, twice a day for a week, and bring the average.
Expert guidelinesOfficial guidelines recommend it, based on trials plus expert judgment.
Blood pressure is diagnosed on an average of several readings across separate occasions, not a single number. Technique matters more than people expect: sit with your back supported and feet flat for five minutes first, arm resting at heart height, cuff on bare skin and correctly sized, no talking, no coffee or exercise in the prior 30 minutes. Take two readings a minute apart, morning and evening. Roughly 1 in 5 people who look hypertensive in a clinic are normal at home (white-coat), and some people with normal clinic readings are high at home (masked) — both change the decision.
ACC/AHA (US)
Graded as out-of-office monitoring (ambulatory or home) to confirm a diagnosis of hypertension.
2025 AHA/ACC Guideline for the Prevention, Detection, Evaluation and… · Recommendation behind this rule · class and level read from the guideline tables on 2026-09-30
Standardized methods for in-office measurement
2025 AHA/ACC Guideline for the Prevention, Detection, Evaluation and… · Graded separately within the same recommendation · class and level read from the guideline tables on 2026-09-30
Out-of-office monitoring to exclude white-coat effect when office pressure is 130/80 or higher
2025 AHA/ACC Guideline for the Prevention, Detection, Evaluation and… · Graded separately within the same recommendation · class and level read from the guideline tables on 2026-09-30
2025 AHA/ACC Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults · Class 1 · Level A
Promising, but not in the guidelines yet.
The <130/80 universal target itself was the frontier position a few years ago. It is now current guideline, not a step ahead of it.
Expert guidelinesOfficial guidelines recommend it, based on trials plus expert judgment.
The <130/80 universal target and the lower drug-initiation threshold for higher-risk groups were themselves the 'frontier' position as recently as a few years ago; they are now current guideline.
If your pressure stays high despite being on medication already, a new drug class was approved in 2026 and lowers it by a real, measured amount. Whether that translates into fewer heart attacks and strokes has not been tested.
Improves test numbersShown: lowers the top number by about 10 more points than a placebo. Not yet shown: fewer heart attacks or strokes.
Baxdrostat blocks the enzyme that makes aldosterone, the hormone behind a meaningful share of hard-to-control hypertension. In BaxHTN, 796 people with uncontrolled or resistant hypertension already on two or more medications were randomised to baxdrostat 1 mg, 2 mg, or placebo for 12 weeks. Systolic blood pressure fell 14.5 mmHg on the 1 mg dose and 15.7 mmHg on 2 mg, against 5.8 mmHg on placebo: a placebo-adjusted reduction of roughly 9 to 10 mmHg, added on top of whatever you are already taking. That is a real, quantified number, and blood pressure is already treated elsewhere on this page as directly consequential to your risk, not merely correlated with it, so a fall of that size is plausibly meaningful for your heart specifically. What has not been done is the outcomes trial: nobody has yet shown that adding this drug prevents more heart attacks or strokes than adding an existing one, and the FDA approval rests on the blood-pressure numbers alone. It is approved specifically as an add-on for uncontrolled hypertension on existing treatment, not as a first medication.
BaxHTN trial and FDA approval of baxdrostat (Baxfendy) for uncontrolled hypertension · Level B
“Atrial fibrillation, blood thinner not yet discussed” — an illustrative profile, not a real user.
Asked after: Higher-risk group for blood pressure
Cited by the recommendations above.
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Runs in lib/engine/bpPathway.ts as lower-threshold-met.