‘I’m a Cardiologist—Here’s How To Know When You Should Go on Blood Pressure Medication' ...Saudi Arabia

As a preventative cardiologist at Vital Heart & Vein, Dr. Patrick Kee, MD, Ph.D has too often seen people discover that they have high blood pressure only after a crisis, like a heart attack, happens to them."We call hypertension the 'silent killer' because it works in the shadows, damaging your vascular system for years without a single outward symptom," Dr. Kee tells Parade.

Unfortunately, a heart attack is not the only scary event or issue that can happen as a result of hypertension. That's why he describes the 2025 American Heart Association and American College of Cardiology blood pressure guidelines as "transformative.""Managing blood pressure is no longer just about avoiding a heart attack," Dr. Kee says. "It's about protecting your brain from dementia and your kidneys from failure."

He adds that managing blood pressure numbers is one of the most important modifiable risk factors for protecting your health and longevity. But how?The good news: There are many tools to help you achieve and maintain healthy blood pressure numbers. Lifestyle habits, such as reducing salt intake, are usually first-line treatments for elevated blood pressure. Yet, sometimes, you may benefit from blood pressure medication.

"Hypertension is a formidable opponent, but under the 2025 guidelines, it is a manageable and preventable condition," he explains. "Through accurate detection and committed change, you have the power to protect your heart, your mind and your future."That sounds like a good foundation for a plan to prevent hypertension from getting in the way of a life you love. Dr. Kee shares how to tell when it's time to start blood pressure medication, using the most up-to-date guidance. Here's what to know before your next doctor's appointment.?SIGN UP for Parade’s health newsletter with expert-approved tips, healthy eats, exercises, news & more to help you stay healthy & feel your best self?

What Your Blood Pressure Numbers Mean

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Before digging into the specifics on what blood pressure readings warrant discussing medication, it's helpful to understand what the numbers even mean. Dr. Kee cites the latest AHA blood pressure guidelines, which state:

Blood pressure category

Systolic (top number)

Diastolic (bottom number)

Normal

< 120 mm Hg

and < 80 mm Hg

Elevated

120–129 mm Hg

and < 80 mm Hg

Stage 1 hypertension

130–139 mm Hg

or 80–89 mm Hg

Stage 2 hypertension

≥ 140 mm Hg

or ≥ 90 mm Hg

Important note: "If your systolic and diastolic numbers fall into different categories, you are designated to the higher category," Dr. Kee explains. "For instance, 135/92 is stage 2 hypertension."

Now, you may look at the chart above and do a double-take. Previous guidelines put the target for healthy blood pressure at 130/80 mm Hg. Now, that's stage 1 Hypertension.

"This '20 is the new 130' sentiment is driven by evidence that lower targets maximize protection against cognitive decline, stroke and total mortality," he reveals. "These categories are designed to trigger intervention earlier, preventing irreversible vascular damage before it escalates."

Related: The Heart-Healthy Habit Cardiologists Say Most People Quit Way Too Soon

Generally, cardiologists will recommend medication (or at least discuss the option) if you have stage 1 hypertension (130–139 mm Hg/80–89 mm Hg). Yet, Dr. Kee emphasizes that cardiologists like himself avoid a one-size-fits-all approach to blood pressure management. They take a lot into account, including your risk factor for hypertension.

"We now use the PREVENT calculator, a tool that estimates your 10-year risk of total cardiovascular disease—including heart failure and kidney function, which older calculators ignored," he explains. "Crucially, this tool is now used for adults starting at age 30."

Here's a general idea of what's probably going through your doctor's mind as they outline your personalized treatment plan for blood pressure:

Stage 1 hypertension + high risk: If you have stage 1 BP (130–139/80 9) AND a PREVENT risk 7.5% or more, diabetes, chronic kidney disease (CKD), or prior heart disease, Dr. Kee says your team will advise you to go on medication right away and make lifestyle changes.Stage 1 hypertension + low risk: "If your risk is less than 7.5%, we recommend a 3- to 6-month trial of lifestyle interventions first," he explains. "If your BP remains at or above 130/80 after this period, we start medication to prevent target organ damage."Stage 2 hypertension (≥140/90): Dr. Kee says it's best to start medication right away, regardless of your PREVENT risk score.

Now, importantly: A doctor won't diagnose hypertension based on one high reading. "A single high reading in a doctor’s office is a signal for investigation, not an automatic diagnosis," Dr. Kee says. "Blood pressure is highly variable and sensitive to your environment."

For instance, you might experience the "white-coat effect" (doctor's office-induced stress). Caffeine and recent exercise can also increase blood pressure. If you get a high reading, the doctor may have you take your blood pressure again later in the visit or ask you to monitor it at home to pinpoint potential patterns.

Related: Cardiologists Are Begging People To Stop Ignoring This Important Cholesterol Number

Strategies for Lowering Blood Pressure Naturally

Medication is a valuable tool for lowering your blood pressure, but it's usually not the first option a cardiologist will reach for.

"Non-pharmacological therapy is the foundation of all management," Dr. Kee notes. "For many, these changes can lower blood pressure as effectively as a first-line medication."

He says you can lower blood pressure through lifestyle habits like:

Sometimes, your team will suggest medication. Dr. Kee says that the first four recommendations are usually:

"For stage 2 patients, the 2025 guidelines prefer a single pill containing two medications," he adds.

Remember, the goal is safety, not shame about your body or lifestyle. "Think of medication as a biological shield," Dr. Kee says. "It is not a sign of failure, but a strategic tool to keep your blood vessels young and protect your heart, brain and kidneys."

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