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, estimates that more than 9 million people who may need medical treatment to achieve optimal blood pressure are not currently receiving it.
The study analyzed data from 81 million U.S. adults with high blood pressure and no cardiovascular disease. Of these, 22.8 million (28%) were guideline-eligible for therapy based on a blood pressure reading of 130/80 mm Hg or higher. Among those eligible, 13.1 million (57%) were already receiving treatment, while 9.7 million (43%) remained untreated. The analysis used the American Heart Association’s PREVENT risk equations to calculate 10-year cardiovascular disease risk.
“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 estimates 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, 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,” 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. 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 2025 guideline emphasizes a personalized approach, using the PREVENT risk equations to identify individuals who could benefit from treatment before a major cardiac event. “Controlling blood pressure is crucial for long-term health,” said Daniel W. Jones, M.D., FAHA, chair of the guideline writing committee. “Healthcare professionals should assess overall cardiovascular risk and work together with their patients to combine lifestyle strategies and medication for optimal blood pressure control.”
Study limitations include that blood pressure was measured during a single office visit for the National Health and Nutrition Examination Survey (NHANES) collected between 2009 and 2018, while the current guideline advises multiple readings. Additionally, the study did not randomly assign treatment, so unmeasured factors may have influenced results.
