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 based on the 2025 American Heart Association/American College of Cardiology guideline. The research, which is one of the first detailed assessments of the updated guideline, found that among 81 million U.S. adults with high blood pressure and no cardiovascular disease, 22.8 million (28%) met the criteria for medication therapy based on a blood pressure reading of 130/80 mm Hg or higher.
The study highlights a significant treatment gap: of those eligible, 13.1 million (57%) were already receiving treatment, while 9.7 million (43%) remained untreated. The analysis estimates that if all eligible adults received blood pressure-lowering medications, approximately 200,000 all-cause deaths and 162,000 cardiovascular deaths could be prevented over the next decade. Among those treated, medication was associated with a 23% lower risk of death from any cause and a 50% lower risk of death from heart-related issues compared to untreated eligible adults.
The 2025 guideline emphasizes a personalized approach, 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. Lifestyle modifications remain the foundation of management, but for those with higher risk, medication is recommended. “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.
The study used data from the National Health and Nutrition Examination Survey (NHANES) collected between 2009 and 2018, with blood pressure measured during a single office visit, which is a limitation. Participants had an average age of 66 and included those with diabetes, chronic kidney disease, and other risk factors. The findings underscore the importance of healthcare professionals assessing overall cardiovascular risk and working with patients to combine lifestyle strategies and medication for optimal blood pressure control. The full manuscript is available online.
