Nearly 23 million U.S. adults with blood pressure readings of 130/80 mm Hg or higher may qualify for blood-pressure-lowering medications under updated clinical recommendations, according to independent research published in the Journal of the American Heart Association. The findings highlight a substantial treatment gap, as over 40% of patients who meet the updated criteria currently remain untreated.
2025 AHA/ACC Guideline Eligibility and Treatment Gap
According to the Journal of the American Heart Association study, roughly 81 million U.S. adults carried a high blood pressure diagnosis during the study window. Of that population, 22.8 million individuals—representing 28%—qualified for medical therapy based on the threshold of 130/80 mm Hg or higher outlined in the 2025 American Heart Association and American College of Cardiology guideline. Out of those eligible, 13.1 million adults (57%) received active treatment, while 9.7 million adults (43%) went untreated.
Study lead author Mustafa Al-Jarshawi, an academic clinical fellow in cardiology at Keele University and honorary research fellow at the University of Manchester, noted the sheer scale of the shortfall. “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 stated.
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Data examined by researchers came from the National Health and Nutrition Examination Survey (NHANES) collected between 2009 and 2018. Study authors note a key limitation: these blood pressure readings relied on a single office visit, whereas current guidelines advise taking multiple measurements across separate visits.
Projected Health Impacts and Saved Lives
Researchers modeled the health outcomes associated with expanding therapy to untreated populations. The analysis estimates that among eligible adults, utilizing blood-pressure-lowering medications correlated with a 23% lower risk of dying from any cause and a 50% lower risk of dying from heart-related conditions, compared to eligible peers receiving no treatment.
If clinicians extend medication treatment to all currently untreated but eligible adults, the analysis projects that roughly 200,000 all-cause deaths and 162,000 cardiovascular deaths could be prevented over the next decade. Patients who stood to benefit most tended to be older, with an average age of 66, and presented with higher rates of concurrent conditions such as diabetes, chronic kidney disease, and existing cardiovascular disease risk factors.
Role of Lifestyle Modifications and PREVENT Risk Equations
The 2025 AHA/ACC guideline continues to position lifestyle changes as the foundation of hypertension management. Recommended interventions include eating a healthy diet, managing weight, getting regular physical activity, reducing salt and alcohol intake, getting enough sleep, and managing stress.
“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,” said study senior author Mamas A. Mamas, professor of cardiology at Keele University. “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.”
To assist healthcare professionals in identifying patients early, the guideline suggests utilizing the American Heart Association’s PREVENT (Predicting Risk of cardiovascular disease EVENTs) equations. These equations calculate 10-year cardiovascular disease risk among adults aged 30 to 79 who lack known cardiovascular disease.
“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,” said Daniel W. Jones, chair of the American Heart Association’s 2025 guideline writing committee, past volunteer president of the AHA, and dean and professor emeritus at the University of Mississippi School of Medicine. Jones was not involved in the new study.
Pro Tip: Healthcare professionals should assess overall cardiovascular risk using the PREVENT risk score and collaborate directly with patients to combine lifestyle strategies with targeted medication for optimal blood pressure control.
Frequently Asked Questions
Who qualifies for blood pressure medication under the 2025 guideline?
Adults with a blood pressure reading of 130/80 mm Hg or higher may be eligible for medication, depending on their overall 10-year and 30-year cardiovascular disease risk calculated using the AHA’s PREVENT equations.
Can lifestyle changes alone replace medication?
According to study senior author Mamas A. Mamas, lifestyle modifications—such as reducing sodium, exercising, and managing weight—can be sufficient at first for individuals with blood pressure under 140/90 mm Hg, no history of heart disease, stroke, chronic kidney disease, or diabetes, and a 10-year PREVENT score under 7.5%.
What is the PREVENT risk equation?
The PREVENT (Predicting Risk of cardiovascular disease EVENTs) equations are risk calculation tools recommended by the American Heart Association to estimate 10-year cardiovascular disease risk among adults aged 30 to 79 without established cardiovascular disease.
How many U.S. adults have high blood pressure?
The research analysis indicated that 81 million U.S. adults carried a diagnosis of high blood pressure during the study evaluation period.
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