Compounding the healthcare burdens for US women are updated hypertension guidelines from the American Heart Association (AHA) that, if followed, will cause doctors to overlook women at risk for heart disease.
Most women think that their leading cause of death is cancer. In fact, cardiovascular disease kills more women than all cancers combined. The latest data from the CDC found that in 2024, heart disease caused 310 661 deaths in the United States, compared with 286 543 linked to cancers.
Hypertension is a leading cause of heart disease. For some women, high blood pressure is a “silent killer” because their reading should sound an alarm that their doctor – following guidelines from the AHA –won’t give.
In 2025, the AHA issued updated clinical guidelines for hypertension to help doctors detect, prevent, and treat high blood pressure and prevent heart disease. The guidelines set four categories for blood pressure: normal, elevated, stage 1 hypertension, and stage 2 hypertension.
Clinicians routinely use these categories to determine their patients’ risk for heart disease, and to advise and treat accordingly.
So far, so good. But although measurable differences exist between the hypertension risk threshold for women and men, and while the authors of the AHA recommendations looked at these differences, they settled on the same risk categories and treatment guidelines for both sexes. (In addition to sex, the authors found that differences in race and ethnicity affect a patient’s risk for hypertension.)
The society has acknowledged that more research needs to be conducted on both gender and race, but in the meantime, the recommendations and guidelines are the same across the board.
In fact, the data on women are already in. A study published in 2021 found women develop cardiovascular disease at a lower blood pressure than do men.
If physicians use the current AHA guidelines, they tell their patients with systolic blood pressure of 120-129 mm Hg that this is normal – because these levels were normal for the larger population on which they based their data.
However, young women with systolic blood pressure between 110-120 mm Hg show increased risk for myocardial infarction, heart failure, and stroke. Thus, rather than consider these female patients “normal”, physicians would be wise to ask follow-up questions about diet, exercise, cholesterol, and family history of heart disease.
In women with systolic blood pressure over 110 mm Hg, doctors will want to follow up with their patients sooner, suggest they use home blood pressure monitors, and advise them to modify their lifestyle if possible or even consider medication depending on other factors.
In the current conditions, a female patient who trusts her doctor, who is relying on the AHA guidelines, could end up with cardiovascular problems that might have been prevented or treated.
The new guidelines misrepresent the data and put women in danger. The AHA already has enough data to update the guidelines with separate categories for women and men, and it should do so.
Instead, the association is relying on flawed hypertension categories in a new report to conclude, problematically, that young women have lower rates of hypertension than men.
There is still work to be done to understand why women and men experience this risk differently. It is unclear why the AHA continues its population-based guidelines for all adults while still acknowledging differences for women.
Historically clinical trials have not analysed hypertension risk by sex. Further, the AHA does acknowledge differences in pregnancy, postpartum care and during menopause.
Many of our research institutions, including the AHA, have begun to include women in their trials and recognise that they have different risk thresholds. But if we truly want to improve women’s health, we must ensure this research is translated into practice.
Nina Stachenfeld, PhD, is a senior research scientist at Yale University School of Medicine, Department of Obstetrics, Gynaecology and Reproductive Sciences. Stachenfeld is also a Public Voices Fellow with The OpEd Project in partnership with Yale University.
Medscape article – What Medicine Gets Wrong About Women’s Blood Pressure (Open access)
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