A new independent 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 eligible for blood-pressure-lowering medications under the 2025 American Heart Association/American College of Cardiology High Blood Pressure guideline. The study, one of the first detailed assessments of the updated guideline, found that among 81 million U.S. adults with high blood pressure and no cardiovascular disease, 22.8 million (28%) met the threshold for therapy based on a blood pressure reading of 130/80 mm Hg or higher.
The research highlights a significant treatment gap: of those eligible, 13.1 million (57%) were already receiving treatment, while 9.7 million (43%) remained untreated. “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 study 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 2025 guideline emphasizes a personalized approach, advising healthcare professionals to use the American Heart Association's PREVENT risk equations to calculate 10-year cardiovascular disease risk among adults ages 30-79 with high blood pressure who do not have established cardiovascular disease. Lifestyle changes remain the foundation of treatment, but medication is recommended when appropriate.
The analysis estimated that, among eligible adults, receiving blood pressure-lowering medications was associated with a 23% lower risk of dying from any cause and a 50% lower risk of dying from heart-related issues, compared to eligible adults who did not receive treatment. If treatment were extended to all untreated but eligible adults, the study estimates approximately 200,000 all-cause deaths and 162,000 cardiovascular deaths could be prevented over the next decade.
“Lifestyle modification remains the foundation of high blood pressure management. Maintaining a healthy weight, consuming a heart-healthy diet, reducing sodium intake, increasing physical activity, getting enough sleep, managing stress and limiting alcohol can meaningfully lower blood pressure and overall cardiovascular risk,” said study 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.”
The study analyzed data from the National Health and Nutrition Examination Survey (NHANES) collected between 2009 and 2018, which included 53% male and 47% female participants. The participants self-identified as 70% white adults, 12% Black adults, 7.2% Mexican American adults, 5.8% multiracial adults and 4.2% other Hispanic adults. Notably, blood pressure was measured during a single office visit, whereas the current guideline advises taking multiple readings during multiple visits, which is an important limitation.
“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,” said Daniel W. Jones, M.D., FAHA, chair of the American Heart Association’s 2025 guideline writing committee. The findings underscore the importance of assessing overall cardiovascular risk and combining lifestyle strategies with medication for optimal blood pressure control.
