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, independent research published today in the Journal of the American Heart Association.
The study, one of the first detailed assessments of the 2025 guideline, analyzed data from 81 million U.S. adults with high blood pressure and no cardiovascular disease. Researchers found that 22.8 million (28%) were guideline-eligible for therapy based on a blood pressure reading of 130/80 mm Hg or higher. Of those, 13.1 million (57%) were already receiving treatment, while 9.7 million (43%) remained untreated.
“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 foundational, but medication is recommended for those at higher risk.
Researchers estimated 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 do not receive treatment. If treatment were extended to all untreated eligible adults, approximately 200,000 all-cause deaths and 162,000 cardiovascular deaths may be prevented over the next decade.
“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.”
The study’s limitations include blood pressure measured during a single office visit rather than multiple visits as recommended, and the observational design cannot prove causation. Nevertheless, the findings underscore the potential impact of the updated guideline on public health.
