Nearly 23 million Americans with blood pressure 130/80 mm Hg or higher may be eligible for blood-pressure-lowering medications based on the 2025 American Heart Association/American College of Cardiology guideline, according to new independent research published in the Journal of the American Heart Association.
The study, 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, 22.8 million (28%) are newly eligible for therapy. Of those, 13.1 million are already receiving treatment, but 9.7 million remain untreated. Researchers estimate that extending medication to all untreated eligible adults could prevent approximately 200,000 all-cause deaths and 162,000 cardiovascular deaths over the next decade.
“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 lead study author Mustafa Al-Jarshawi, M.B.Ch.B., M.Sc., an academic clinical fellow in cardiology at Keele University in the United Kingdom.
The 2025 guideline, issued by the American Heart Association and the American College of Cardiology, recommends lifestyle changes as a foundation for managing high blood pressure, including a healthy diet, weight management, regular physical activity, and reduced salt and alcohol intake. Medication is prescribed if appropriate. The guideline also advises using the American Heart Association’s PREVENT risk equations to calculate 10-year cardiovascular disease risk for adults ages 30-79 with high blood pressure but no established cardiovascular disease.
In the study, researchers analyzed data from the National Health and Nutrition Examination Survey (NHANES) collected between 2009 and 2018. They found that people eligible for medication who would benefit most were older, with an average age of 66, and had more health conditions such as 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 not receiving treatment.
“Lifestyle modification remains the foundation of high blood pressure management,” said 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, 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 may also need medication to reduce the risk of serious complications.”
The study had limitations, including blood pressure measured during a single office visit rather than multiple visits as recommended, and the inability to capture changes in treatment over time. Nevertheless, the findings underscore the potential impact of the updated guidelines on public health.
