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 guideline. The research, 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, approximately 22.8 million (28%) meet the threshold for medication based on a blood pressure reading of 130/80 mm Hg or higher.
Of these eligible individuals, 13.1 million (57%) were already receiving treatment, while 9.7 million (43%) remained untreated. The analysis suggests that 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. The study also found 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 who did not receive treatment.
The 2025 guideline, developed by the American Heart Association and the American College of Cardiology, emphasizes lifestyle modifications—such as a healthy diet, weight management, regular physical activity, and reduced salt and alcohol intake—as foundational to blood pressure management. 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 with high blood pressure but no established cardiovascular disease. Those with higher risk 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 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 study examined data from the National Health and Nutrition Examination Survey (NHANES) collected between 2009 and 2018, noting that blood pressure readings were taken during a single office visit, which is a limitation since the guideline recommends multiple readings over multiple visits.
People who would benefit most from medication were older, with an average age of 66, and had more health conditions such as diabetes, chronic kidney disease, and other cardiovascular risk factors. “Lifestyle modification remains the foundation of high blood pressure management,” 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.”
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. The findings underscore the importance of assessing overall cardiovascular risk and combining lifestyle strategies with medication for optimal blood pressure control.
