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 research published today in the Journal of the American Heart Association.
The study, one of the first detailed assessments of the 2025 guideline, found that among 81 million U.S. adults with high blood pressure and no cardiovascular disease, nearly 23 million (28%) may be newly eligible for medication. Of those, 13.1 million were already receiving treatment, but 9.7 million remained untreated. The analysis estimates that if treatment were extended to all untreated eligible adults, approximately 200,000 all-cause deaths and 162,000 cardiovascular deaths could be prevented 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 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 2025 guideline, issued by the American Heart Association and American College of Cardiology, advises lifestyle changes as a key part of treatment and recommends healthcare professionals use the American Heart Association’s PREVENT risk equations to calculate 10-year cardiovascular disease risk among adults ages 30-79 with high blood pressure who do not have established cardiovascular disease.
“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 study analyzed data from the National Health and Nutrition Examination Survey collected between 2009 and 2018, which included 53% male and 47% female participants. Among the participants, 9.4% had chronic kidney disease, 17% had diabetes, 47% had dyslipidemia, and 15% were current smokers. Self-identified race/ethnicity included 70% white adults, 12% Black adults, 7.2% Mexican American adults, 5.8% multiracial adults, and 4.2% other Hispanic adults.
“Controlling blood pressure is crucial for long-term health,” said Daniel W. Jones, M.D., FAHA, chair of the 2025 guideline writing committee. “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 findings highlight the importance of addressing the treatment gap, particularly for older adults and those with additional health conditions, who may benefit most from medication. The study limitations include that blood pressure was measured during a single office visit and that researchers examined treatment at only one point in time, so the study could not capture changes in medication use over time.
