A study published today in the Journal of the American Heart Association reveals that nearly 23 million U.S. adults with high blood pressure may be newly eligible for blood-pressure-lowering medications under the 2025 American Heart Association/American College of Cardiology High Blood Pressure guideline. The independent analysis, which evaluated data from 81 million adults with hypertension and no cardiovascular disease, found that 28% (22.8 million) qualify for treatment based on a blood pressure reading of 130/80 mm Hg or higher. Of those, 13.1 million (57%) were already receiving treatment, while 9.7 million (43%) remained untreated.
The 2025 guideline emphasizes lifestyle modifications—such as a healthy diet, weight management, regular physical activity, and reduced sodium and alcohol intake—as foundational for blood pressure control. However, it also recommends that healthcare professionals use the American Heart Association’s PREVENT risk equations to calculate 10-year cardiovascular disease risk for adults aged 30-79 without known cardiovascular disease. This personalized approach allows clinicians to identify patients who may benefit from medication in addition to lifestyle changes.
“What stood out most was the size of the treatment gap—more than 40% of people who were clearly eligible under the new guideline were not receiving treatment, as well as the scale of the potential benefit,” said lead author Mustafa Al-Jarshawi, M.B.Ch.B., M.Sc., MRCPUK, PgCert, an academic clinical fellow in cardiology at Keele University in the United Kingdom. The study estimated that if all untreated eligible adults received blood pressure-lowering medications, approximately 200,000 all-cause deaths and 162,000 cardiovascular deaths could be prevented over the next decade. Among treated individuals, medication was associated with a 23% lower risk of death from any cause and a 50% lower risk of cardiovascular death compared to those not receiving treatment.
People most likely to benefit were older (average age 66) and had additional health conditions such as diabetes, chronic kidney disease, or other cardiovascular risk factors. “Lifestyle modification remains the foundation of high blood pressure management,” said senior author Mamas A. Mamas, M.D., DPhil., professor of cardiology at Keele University. “For many people, especially those with blood pressure under 140/90 mm Hg and no history of heart disease, stroke, chronic kidney disease, or diabetes, lifestyle changes can be enough at first. If your 10-year risk of heart disease is low, with a PREVENT score under 7.5%, maintaining a healthy lifestyle can help you delay or avoid needing medication.”
Daniel W. Jones, M.D., FAHA, chair of the 2025 guideline writing committee, noted that “controlling blood pressure is crucial for long-term health. While lifestyle changes are the foundation for better overall health, people with high blood pressure and higher risk for cardiovascular disease may also need medication to reduce the risk of serious complications from untreated high blood pressure.” The study, which analyzed data from the National Health and Nutrition Examination Survey (NHANES) collected between 2009 and 2018, had limitations including single blood pressure measurements and lack of randomization. Nonetheless, the findings underscore the importance of implementing the updated guideline to address a significant treatment gap and improve cardiovascular outcomes nationwide.
