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 newly eligible for blood pressure-lowering medication under the 2025 American Heart Association/American College of Cardiology High Blood Pressure guideline. The research, which analyzed data from 81 million adults with high blood pressure and no cardiovascular disease, found that 28% (22.8 million) meet the guideline's threshold of 130/80 mm Hg or higher for medication consideration. Of those eligible, 13.1 million (57%) are already receiving treatment, leaving 9.7 million (43%) untreated.
The study is one of the first detailed assessments of the 2025 guideline, which incorporates the American Heart Association's PREVENT risk equations to calculate 10-year cardiovascular disease risk. Researchers estimated that if all eligible untreated adults received medication, approximately 200,000 all-cause deaths and 162,000 cardiovascular deaths could be prevented over the next decade. Among those receiving treatment, the analysis associated a 23% lower risk of death from any cause and a 50% lower risk of heart-related death compared to untreated eligible adults.
"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 used data from the National Health and Nutrition Examination Survey (NHANES) collected between 2009 and 2018, with blood pressure measured during a single office visit—a limitation noted by the authors.
Study senior author Mamas A. Mamas, M.D, DPhil., professor of cardiology at Keele University, emphasized that lifestyle modifications remain foundational. "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. The 2025 guideline recommends lifestyle changes—including a healthy diet, weight management, physical activity, and reduced salt and alcohol—alongside medication when appropriate.
Daniel W. Jones, M.D., FAHA, chair of the guideline writing committee, noted that the PREVENT risk equations help identify individuals who could benefit from treatment before a major cardiac event. "Controlling blood pressure is crucial for long-term health," Jones said. "Healthcare professionals should assess overall cardiovascular risk and work together with their patients to combine lifestyle strategies and medication for optimal blood pressure control."
The study participants were 53% male and 47% female, with 9.4% having chronic kidney disease, 17% diabetes, and 15% current smokers. The analysis suggests that people eligible for treatment who would benefit most are older, with an average age of 66, and have more health conditions. The findings underscore the importance of personalized treatment approaches and closing the treatment gap to reduce cardiovascular mortality.
