A new 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 medications under the 2025 American Heart Association/American College of Cardiology High Blood Pressure guideline. The research, which is 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 28% (22.8 million) meet the criteria for medication therapy based on a blood pressure reading of 130/80 mm Hg or higher.
The study highlights a significant treatment gap: while 13.1 million of these eligible adults are already receiving treatment, 9.7 million (43%) remain untreated. According to the analysis, extending medication to all untreated but eligible individuals could prevent approximately 200,000 all-cause deaths and 162,000 cardiovascular deaths over the next decade. The findings underscore the potential impact of the 2025 guideline, which emphasizes a personalized approach to managing high blood pressure by incorporating both blood pressure levels and cardiovascular disease risk, calculated using the American Heart Association’s PREVENT risk equations.
“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, published in the Journal of the American Heart Association, analyzed data from the National Health and Nutrition Examination Survey (NHANES) collected between 2009 and 2018, though the authors note that blood pressure was measured during a single office visit, which is a limitation.
The 2025 guideline advises lifestyle changes—such as eating a healthy diet, managing weight, getting regular physical activity, and reducing salt and alcohol—as a foundation for blood pressure management, with medication prescribed when appropriate. “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.”
The analysis also found that people eligible for medication 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. 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 those who did not receive treatment.
Daniel W. Jones, M.D., FAHA, chair of the 2025 guideline writing committee, emphasized the importance of a personalized approach: “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 study’s findings reinforce the need for healthcare professionals to assess overall cardiovascular risk and collaborate with patients to combine lifestyle strategies and medication for optimal blood pressure control.
