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 research, one of the first detailed assessments of the updated guideline, found that 28% of the 81 million adults with diagnosed hypertension and no cardiovascular disease meet the criteria for pharmacologic therapy.
The 2025 guideline recommends lifestyle modifications—healthy diet, weight management, physical activity, and reduced salt and alcohol intake—as foundational treatment, with medication added based on blood pressure levels and cardiovascular risk. It also incorporates the American Heart Association’s PREVENT risk equations to estimate 10-year cardiovascular disease risk. The study analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2018, including 81 million adults with high blood pressure.
Of the 22.8 million newly eligible for medication, 13.1 million (57%) were already receiving treatment, while 9.7 million (43%) remained untreated. The analysis estimated that receiving blood pressure-lowering medication was associated with a 23% lower risk of death from any cause and a 50% lower risk of cardiovascular death, compared to eligible adults who did not receive treatment. Extending medication to all untreated eligible adults could prevent approximately 200,000 all-cause deaths and 162,000 cardiovascular deaths over the next decade.
“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 noted that those who would benefit most were older (average age 66) and had more health conditions such as diabetes, chronic kidney disease, and other cardiovascular risk factors.
Senior author Mamas A. Mamas, M.D., DPhil., professor of cardiology at Keele University, emphasized that lifestyle modification remains critical. “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 and past volunteer president of the American Heart Association, added that the guideline emphasizes a personalized approach. “The 2025 guideline emphasizes a personalized approach to managing high blood pressure by considering blood pressure levels plus 10-year and 30-year overall cardiovascular disease risk. The American Heart Association’s PREVENT risk equations help to identify individuals who could benefit from treatment before a major cardiac event.”
Study limitations include that blood pressure was measured during a single office visit, whereas the guideline recommends multiple readings. The study also did not randomly assign treatment, so unmeasured factors may have influenced results. Despite these limitations, the findings highlight a significant opportunity to improve cardiovascular health through wider application of the updated guideline.
