What determines blood pressure?
Blood pressure is the product of two things: how much blood your heart pumps per minute (cardiac output), and how much resistance your blood vessels put up against that flow (systemic vascular resistance). A reading of, say, 118/76 mmHg reflects two moments in a single heartbeat: systolic pressure, the peak as the heart contracts, and diastolic pressure, the level while the heart rests between beats.
Because it's a product of two variable systems, blood pressure can rise from either side of the equation — more blood pumped, tighter vessels, or both — which is part of why treatment approaches differ from person to person.
How does the body regulate blood pressure?
Several systems work continuously to keep blood pressure in range. Among the most important is the renin-angiotensin-aldosterone system (RAAS), which links the kidneys, blood volume and vessel tone into a single feedback loop.
Two other factors matter over the longer term: arterial stiffness, which tends to increase with age as vessel walls lose elasticity, and endothelial function — the health of the thin cell layer lining blood vessels, which helps them dilate and constrict appropriately.
What is a healthy blood pressure?
In August 2025, the American Heart Association, American College of Cardiology and eleven other medical societies jointly published an updated guideline — the first full replacement of the 2017 framework. The diagnostic categories themselves didn't change, but the guideline strengthened encouragement toward lower targets for many adults and introduced a newer 10-year cardiovascular risk calculator (PREVENT) to help individualize treatment decisions.
The diagnostic threshold (≥130/80 mmHg) is not the same as the treatment target. Current guidance recommends a target below 130/80 mmHg for most adults on treatment, with encouragement toward below 120 mmHg systolic where it can be achieved safely.
What raises blood pressure?
Sodium intake, excess body weight, physical inactivity, high alcohol intake and chronic stress are established modifiable contributors. Age-related arterial stiffness, kidney disease, sleep apnea and genetics contribute independently of lifestyle. Guidelines consistently recommend addressing lifestyle factors first — the 2025 update reinforces this — while noting that a meaningful share of people will still need medication to reach target.
What does current research show?
A potassium-enriched salt substitute reduced stroke, cardiovascular events and death
In the SSaSS trial, replacing regular salt with a reduced-sodium, potassium-enriched substitute lowered stroke risk by 14%, major cardiovascular events by 13%, and death from any cause by 12% over five years, with no signal of harm from elevated potassium in this population.
Participants were older adults or people with prior stroke or hypertension in one country; people with significant kidney disease — who can be vulnerable to high potassium — were excluded, so this specific approach isn't appropriate for everyone.
Magnesium supplementation modestly lowers blood pressure, mainly in specific groups
A 2025 meta-analysis found magnesium supplementation reduced systolic blood pressure by ~2.8 mmHg and diastolic by ~2.1 mmHg on average, with considerably larger effects in people already on blood-pressure medication or with low magnesium levels.
The effect was not statistically significant in people with normal blood pressure, and the authors flagged high heterogeneity across the underlying trials — larger, more standardized studies are still needed.
What remains uncertain
- Why are some people far more "salt-sensitive" than others, even at similar sodium intakes?
- What's the right blood pressure target for older or frail adults, where lower isn't automatically better?
- Why does home blood pressure monitoring — the recommended gold standard — remain so underused despite strong guideline support?
- How much of an individual's long-term cardiovascular risk is explained by blood pressure alone versus its interaction with cholesterol, glucose and inflammation?
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References & Further Reading
- 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults.
- Effect of Salt Substitution on Cardiovascular Events and Death.
- Magnesium Supplementation and Blood Pressure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.