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 eligible for blood-pressure-lowering medications under the 2025 American Heart Association/American College of Cardiology guideline. The research, one of the first detailed assessments of the updated guideline, found that among 81 million adults with hypertension and no cardiovascular disease, 22.8 million (28%) qualify for therapy based on a blood pressure reading of 130/80 mm Hg or higher.
The 2025 guideline emphasizes lifestyle changes such as a healthy diet, weight management, regular physical activity, and reducing salt and alcohol intake as foundational treatment. It also recommends using the American Heart Association’s PREVENT risk equations to calculate 10-year cardiovascular disease risk for adults aged 30-79 without known cardiovascular disease. 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, noted that the goal was to understand how many people qualify for treatment and estimate potential deaths prevented if recommendations were applied.
The analysis of data from the National Health and Nutrition Examination Survey (NHANES) collected between 2009 and 2018 found that 13.1 million (57%) of eligible adults were already receiving treatment, while 9.7 million (43%) remained untreated. Researchers estimated that 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 not receiving treatment. If all untreated eligible adults received medication, approximately 200,000 all-cause deaths and 162,000 cardiovascular deaths could be prevented over the next decade.
People who would benefit most were older, with an average age of 66, and had more health conditions, including diabetes, chronic kidney disease, and other cardiovascular risk factors. Study senior author Mamas A. Mamas, M.D, DPhil., Professor of Cardiology at Keele University, emphasized that lifestyle modification remains the foundation of high blood pressure management. "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," he said.
Daniel W. Jones, M.D., FAHA, chair of the 2025 guideline writing committee and past volunteer president of the American Heart Association, noted that the guideline emphasizes a personalized approach. "Controlling blood pressure is crucial for long-term health. While lifestyle changes are the foundation, people with high blood pressure and higher risk for cardiovascular disease may also need medication to reduce the risk of serious complications," he said.
Study limitations include that blood pressure was measured during a single office visit, whereas the current guideline recommends multiple readings. Researchers also did not randomly assign treatment, so other unmeasured factors may have influenced results. The study was published in the Journal of the American Heart Association, an open access, peer-reviewed journal.
