Healthy blood pressure: why so few people reach it, and the new map from the American Heart Association

Healthy blood pressure: a number you rarely think about

You feel fine, and a healthy blood pressure is the last thing on your mind. You cycle or drive to work, sit through a morning full of meetings, eat lunch at your desk and take the stairs without a second thought. At the end of the day you sink into the sofa. Nothing hurts, nothing feels odd. It has been a while since anyone put a cuff around your arm, and you no longer remember what the monitor showed. Blood pressure is one of those things where you assume you have a healthy blood pressure, until someone tells you otherwise.

That is the strange thing about it. Raised blood pressure is often something you do not notice yourself, so the only way to know is to measure it. And one reading is only the beginning: the number has to be known, followed up and discussed, sometimes for years. Somewhere along that chain, the story stops for a great many people.

You are far from the only one

In the Netherlands, 15.4% of the people surveyed said they had high blood pressure in the past 12 months, now or at some point. These are self-reported figures for 2023 to 2025, which the RIVM published in 2026 through VZinfo.⁠² That is roughly one in seven people, and it only counts those who know.

In the European Union, 22% of people aged 15 and over had high blood pressure in the 2019 health survey, and with 16%, the Netherlands was among the countries with the lowest share (Eurostat, 2021).⁠⁴ Worldwide, the NCD Risk Factor Collaboration found that the number of people aged 30 to 79 with high blood pressure doubled between 1990 and 2019, to 626 million women and 652 million men (The Lancet, 2021).⁠⁵ In the United States alone, the American Heart Association counts about 122.4 million adults with high blood pressure (2026).⁠¹

If you want a first indication of how your own heart and blood vessels are doing, the BioProfile heart and blood vessel scan gives you a starting point. The scan is not a diagnosis. It is about insight, about seeing where you stand today.

Why a reading stays too high

In the United States, only 20.7% of people who know they have high blood pressure reach readings below 130/80 mm Hg, the level the American Heart Association counts as under control, even though effective options do exist.⁠¹ Put simply: of every five people who already know, about four do not get that far.

The reasons are rarely one thing. A reading has to be taken, repeated and discussed; care has to be within reach and followed through; and daily life, from your work to your neighbourhood, decides how much room there is for all of that. The differences in control also persist between racial, ethnic, socioeconomic and geographic groups.⁠¹

What was already known, and where it stopped

In 2013, an earlier scientific advisory from the American Heart Association, the American College of Cardiology and the Centers for Disease Control and Prevention argued that a whole system works better than separate efforts: fixed steps in care, good record keeping, feedback, team-based care and involving patients, families and health systems, rather than information alone.⁠⁶

One large American health system showed what that can look like. At Kaiser Permanente Northern California, the share of people with high blood pressure under control rose from 43.6% in 2001 to 80.4% in 2009, from less than half to about four in five, while the national average rose much less, from 55.4% to 64.1%.⁠⁷ That study followed a pattern over time rather than running an experiment, so it does not show that the programme alone caused the rise. It does show that the rise and the programme went together.

Worldwide the gap stayed wide: in 2019 blood pressure was under control in 23% of women and 18% of men with high blood pressure, and some middle-income countries now do better than most high-income countries.⁠⁵ That is where knowledge stopped. An organised system within a single care setting could raise the numbers, but there was no shared plan for everything outside the consulting room: the neighbourhood, the workplace, information that fits the people it is meant for, all working at the same time and all measured.

A new map from the American Heart Association

On 29 September 2026, the journal Hypertension published a scientific advisory titled “American Heart Association’s Strategic Approach to Promoting Blood Pressure Control”.⁠¹ The authors are Y. Commodore-Mensah, B.K. Bellows, A.P. Smith, J.T. Flynn, A.D. Pressley, S. Honeycutt, E. Sanchez, M. Abdalla and S. Nesbitt, who write on behalf of the American Heart Association and several of the association’s scientific councils. The database listing does not say where each author works. It is not a preprint but an article in a journal.

The advisory does not report a new experiment. It presents the American Heart Association Blood Pressure Control Logic Model: a visual framework of how resources and activities in healthcare and in the community are meant to lead to results. The association has made blood pressure control that is fairly shared across groups one of its central priorities, and this model is the plan that goes with that choice.

Why this matters to you: most of what decides whether a blood pressure stays within a healthy range happens outside the short time in a consulting room. It happens at work, at home, in the information you receive and in whether someone measures again. A plan that takes those places seriously is a plan about your ordinary days.

What a logic model is

The one idea worth understanding here is the logic model itself. It sounds technical, but it is a way of thinking you probably already use.

A logic model is a chain of “if this, then that” steps on a single page: what you put in, what you do with it, what you expect to change, and the bigger effect you are aiming for. Each link has to hold before the next one can.

In the advisory, the chain runs like this.⁠¹ The inputs are what an organisation brings: staff expertise, data systems, funding and partnerships. Those inputs flow through four strategies: changing the healthcare environment through research and policy reform; education that fits the culture of the people it is meant for; better quality of clinical care; and involving community organisations and workplaces in health promotion. Those activities lead to measurable outcomes, and the outcomes lead to effects on the whole population: fairer results and a lower chance of problems with the heart and blood vessels.

Two features make this more than a diagram. The four strategies are meant to run at the same time: information without better care, or better care that nobody nearby hears about, leaves a link loose. And the model has a plan say in advance what it will measure, which is why the statement stresses thorough evaluation and lasting collaboration between sectors. A chain you cannot test is only a wish. The authors call the model adaptable, so that other organisations can use it too.

Two places the map reaches: the consulting room and the workplace

The model becomes clearer when you hang a real situation on it.

The first example is the doctor’s surgery. The Kaiser Permanente programme fits neatly onto the map.⁠⁷ A register of everyone with high blood pressure and shared performance figures are inputs: data systems. Guidelines and appointments with a medical assistant just to have your blood pressure measured are activities within the strategy of better clinical care. The rising share of people with their blood pressure under control is the outcome. In the terms of a logic model, it was one strong chain within one health system.

The second example is the workplace, which the advisory names as one of the places to involve.⁠¹ The summary does not describe a specific workplace programme, so do not read this as something the advisory reports, but as an illustration of the map. A partnership with an employer is the input. A moment at work when people can have their blood pressure measured and hear in plain words what the number means is the activity. The outcome to measure is how many employees know their own readings and take next steps with them. You spend a large part of your waking hours at work, and that is exactly why the advisory puts the workplace on the same page as the doctor’s surgery.

Why the age of 40 matters

A chain only works if people step into it, and many people do so late. Mirjam Wolder of the Hartstichting put it clearly.⁠³

High blood pressure is often seen as a complaint of old age, while the chance of it already rises from the age of 40.

Mirjam Wolder, programme manager Eerder Opsporen, Hartstichting

In other words: high blood pressure is often seen as a complaint of old age, while the chance of it already starts to rise from 40. David Smeekes, a doctor at the same foundation, links that age to measuring.⁠⁸

From the age of 40, you are more likely to have high blood pressure, for men and women alike.

David Smeekes, doctor, Hartstichting

In other words: from 40, men and women alike run a higher chance. A measured number is the first link in every chain in the advice: before care, health information or a programme at work can do anything, a number has to be known.

What the statement did and did not show

The advisory set out a plan: an adaptable map of how organisations can work together on blood pressure.⁠¹

Who: no one, in the sense of a study. The advisory is not an experiment but a framework. No group of people was studied, so there is no population and no size to report; the background figures describe adults in the United States.

What the statement did not show weighs just as much. It reports no new measured outcome, and it does not show that organisations using the model end up with more people whose blood pressure is under control; according to the statement, that is exactly what still needs to be evaluated. How well an American plan carries over to the Dutch system, with the central role of the GP, is not mentioned. And BioProfile has not read the full text, only the abstract.

What you can do now

Know your own numbers. Have your blood pressure measured, at your GP practice or at home. If you measure at home, Thuisarts explains how to do it and asks you to bring your readings to your next appointment, so a GP sees the whole picture rather than a single moment.⁠⁹ A heart rate is a different number; what counts as normal is explained in our article on a normal heart rate.

Look at how much you sit. Your working day is one of the places the advice points to, and a place where you decide a lot yourself. What moving too little does to your body is explained in our article on moving too little.

Find out where you stand. The open question after reading about a plan like this is a personal one: how are your own heart and blood vessels doing today, and where would you start? The heart and vascular scan gives you a first indication, a starting point to come back to.