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, one of the first detailed assessments of the updated guideline, highlights a significant treatment gap and the potential to prevent hundreds of thousands of deaths.
Researchers analyzed data from 81 million U.S. adults with high blood pressure and no cardiovascular disease. They found that 22.8 million (28%) were eligible for therapy based on a blood pressure reading of 130/80 mm Hg or higher. Among those eligible, 13.1 million (57%) were already receiving treatment, while 9.7 million (43%) remained untreated. The study estimates that if all untreated eligible adults received medication, 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 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 lifestyle changes as the foundation of high blood pressure management, including a heart-healthy diet, weight management, physical activity, and reduced sodium and alcohol intake. Medication is prescribed when appropriate, especially for those with higher cardiovascular risk. The guideline also recommends using the American Heart Association’s PREVENT risk equations to calculate 10-year cardiovascular disease risk for adults ages 30-79 without known cardiovascular disease.
Senior author Mamas A. Mamas, M.D., DPhil., professor of cardiology at Keele University, noted that 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 sufficient initially. However, for those with higher risk, medication may be necessary. “Even if you do need medication to lower blood pressure, making lifestyle changes is important for effective treatment and overall health,” he said.
The study also 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. Those 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.
Daniel W. Jones, M.D., FAHA, chair of the guideline writing committee, emphasized the personalized approach of the 2025 guideline. “The American Heart Association’s PREVENT risk equations help to identify individuals who could benefit from treatment before a major cardiac event,” he said. “Controlling blood pressure is crucial for long-term health.”
Study limitations include that blood pressure was measured during a single office visit, whereas the guideline recommends multiple readings. Additionally, the study did not randomly assign treatment, so unmeasured factors may have influenced results. Nonetheless, the findings underscore the importance of addressing the treatment gap to reduce cardiovascular mortality.
