A new independent study published 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 medication under the 2025 American Heart Association/American College of Cardiology High Blood Pressure guideline. The research, which analyzed data from 81 million adults with hypertension and no prior cardiovascular disease, found that 28% (approximately 22.8 million) meet the guideline's criteria for pharmacological treatment, with blood pressure readings of 130/80 mm Hg or higher. Alarmingly, more than 9.7 million of these individuals (43%) are not currently receiving any medication, representing a significant treatment gap.
The 2025 guideline emphasizes a personalized approach, incorporating lifestyle modifications as a cornerstone of management while recommending medication based on blood pressure levels and cardiovascular risk, calculated using the American Heart Association’s PREVENT risk equations. The study is one of the first to assess the real-world impact of these updated recommendations, estimating that extending treatment to all eligible untreated 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, an academic clinical fellow in cardiology at Keele University in the United Kingdom. The analysis found that among eligible adults, those receiving blood pressure-lowering medications had a 23% lower risk of dying from any cause and a 50% lower risk of dying from heart-related issues compared to those who remained untreated.
"Lifestyle modification remains the foundation of high blood pressure management," emphasized 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."
The study's findings underscore the importance of the 2025 guideline's shift toward earlier and more aggressive treatment, particularly for older adults and those with comorbidities such as diabetes, chronic kidney disease, or other cardiovascular risk factors. The average age of participants who would benefit most was 66. However, the researchers caution that the study relied on single blood pressure measurements from the National Health and Nutrition Examination Survey (NHANES), which may not reflect the multiple readings recommended for diagnosis.
Dr. Daniel W. Jones, chair of the 2025 guideline writing committee, noted, "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 full manuscript is available in the Journal of the American Heart Association.
