A new independent study published in the Journal of the American Heart Association reveals that nearly 23 million U.S. adults with high blood pressure may be eligible for blood-pressure-lowering medications under the 2025 American Heart Association/American College of Cardiology High Blood Pressure guideline. The research, which analyzed data from 81 million adults with hypertension and no prior cardiovascular disease, found that 28%—or 22.8 million—meet the guideline's threshold of 130/80 mm Hg or higher for medication consideration.
Among these eligible individuals, 13.1 million (57%) were already receiving treatment, while 9.7 million (43%) remained untreated. This treatment gap is a key concern highlighted by the study's lead author, Mustafa Al-Jarshawi, M.B.Ch.B., M.Sc., an academic clinical fellow in cardiology at Keele University. “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,” Al-Jarshawi said.
The 2025 guideline, developed by the American Heart Association and the American College of Cardiology, emphasizes a personalized approach to managing high blood pressure. It recommends lifestyle changes—such as a heart-healthy diet, regular physical activity, weight management, and reducing salt and alcohol—as a foundation for treatment, with medication prescribed when appropriate. Healthcare professionals are advised to use the American Heart Association’s PREVENT risk equations to calculate 10-year and 30-year cardiovascular disease risk in adults aged 30-79 without known cardiovascular disease.
The study's analysis estimated that 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 who did not receive treatment. Extending medication to all untreated eligible adults could prevent approximately 200,000 all-cause deaths and 162,000 cardiovascular deaths over the next decade, according to the researchers.
People who would benefit most from medication were older, with an average age of 66, and had more health conditions such as diabetes, chronic kidney disease, and other cardiovascular risk factors. The study also noted that 53% of participants were male, 47% female, and the cohort included 70% white adults, 12% Black adults, 7.2% Mexican American adults, 5.8% multiracial adults, and 4.2% other Hispanic adults.
Senior study author Mamas A. Mamas, M.D., DPhil., professor of cardiology at Keele University, stressed that lifestyle modification remains crucial. “Maintaining a healthy weight, consuming a heart-healthy diet, reducing sodium intake, increasing physical activity, getting enough sleep, managing stress and limiting alcohol can meaningfully lower blood pressure and overall cardiovascular risk,” Mamas said. For those with blood pressure under 140/90 mm Hg and no history of heart disease, stroke, chronic kidney disease, or diabetes, lifestyle changes alone may be sufficient initially. However, for individuals with higher cardiovascular risk, combining lifestyle changes with medication is an effective strategy.
Daniel W. Jones, M.D., FAHA, chair of the 2025 guideline writing committee, noted, “The 2025 guideline emphasizes a personalized approach to managing high blood pressure by considering blood pressure levels plus 10-year and 30-year overall cardiovascular disease risk. The American Heart Association’s PREVENT risk equations help to identify individuals who could benefit from treatment before a major cardiac event.”
Jones added that controlling blood pressure is crucial for long-term health, and healthcare professionals should assess overall cardiovascular risk and work with patients to combine lifestyle strategies and medication for optimal control. The study's limitations include that blood pressure was measured during a single office visit, whereas the guideline recommends multiple readings over multiple visits, and the analysis could not account for changes in treatment over time.
