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 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) are now eligible for therapy based on a blood pressure reading of 130/80 mm Hg or higher. Of these, 13.1 million (57%) were already receiving treatment, leaving 9.7 million (43%) untreated.
The study is one of the first to assess the 2025 guideline, which emphasizes lifestyle changes such as a healthy diet, weight management, regular physical activity, and reduced salt and alcohol intake, alongside medication when appropriate. The guideline also recommends using the American Heart Association’s PREVENT risk equations to calculate 10-year cardiovascular disease risk for adults aged 30-79 without known cardiovascular disease.
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, said the goal was to understand how many people qualify for treatment and estimate potential lives saved. 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. 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.
Senior author Mamas A. Mamas, M.D., DPhil., Professor of Cardiology at Keele University, stressed that lifestyle modification remains the foundation of high blood pressure 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," Mamas said. "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."
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," said Jones, a past volunteer president of the American Heart Association. "While lifestyle changes are the foundation, people with high blood pressure and higher risk for cardiovascular disease 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 researchers did not randomly assign treatment. The findings highlight a significant treatment gap and underscore the potential benefits of expanding medication use to eligible adults. More information about the study can be found in the manuscript published in the Journal of the American Heart Association.
