Nearly 23 Million U.S. Adults May Be Newly Eligible for Blood Pressure Medication Under 2025 Guideline

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 medication under the 2025 American Heart Association/American College of Cardiology guideline. The research, which analyzed data from 81 million adults with hypertension and no cardiovascular disease, found that 28% (22.8 million) meet the guideline's threshold for medication therapy based on a blood pressure reading of 130/80 mm Hg or higher.

Of those eligible, 13.1 million (57%) were already receiving treatment, while 9.7 million (43%) remained untreated. The study estimates 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. The analysis found that 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.

"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 emphasizes a personalized approach, using the American Heart Association's PREVENT risk equations to calculate 10-year cardiovascular disease risk. Lifestyle changes remain the foundation of management. "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," said study senior author Mamas A. Mamas, M.D, DPhil., professor of cardiology at Keele University.

Daniel W. Jones, M.D., FAHA, chair of the 2025 guideline writing committee, noted, "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."

Study limitations include that blood pressure was measured during a single office visit, whereas the guideline recommends multiple readings. The researchers did not randomly assign treatment, so unmeasured factors may have influenced results.