At or above 140/90? No
standard-threshold-not-metFewer than 5 people have reached this rule so farLifestyle for 3–6 months; if still ≥130/80, start medication (Class I)
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.
Start with lifestyle — but this is not open-ended. If your blood pressure is still at or above 130/80 after three to six months of genuinely trying, medication is recommended, not optional.
Expert guidelinesOfficial guidelines recommend it, based on trials plus expert judgment.
Your reading (132/82 mmHg) is between the target and the immediate drug-therapy threshold for your risk profile. The 2025 guideline is specific about what happens next: sodium reduction, weight management, activity, and cutting alcohol first — and if the pressure is still 130/80 or above after three to six months, starting medication is a Class I recommendation regardless of where your calculated risk sits. The lifestyle period is a trial with an endpoint, not an indefinite alternative to treatment.
ACC/AHA (US)
Graded for adults without clinical cardiovascular disease and with 10-year PREVENT-CVD risk under 7.5%: if systolic stays at 130 or higher, or diastolic at 80 or higher, after a 3 to 6 month lifestyle trial, medication is recommended.
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
Lifestyle: weight loss, a DASH-style diet, less sodium, limited alcohol and structured exercise
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 B-R
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.
“Borderline risk + high Lp(a)” — an illustrative profile, not a real user.
Asked after: Standard-risk group for blood pressure
Cited by the recommendations above.
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Runs in lib/engine/bpPathway.ts as standard-threshold-not-met.