Under updated American cardiovascular guidelines, a blood pressure reading of 130/80 mm Hg now prompts consideration of medication alongside lifestyle changes, sweeping 22.8 million U.S. adults with high blood pressure and no heart disease into treatment eligibility, according to a population-level analysis published in the Journal of the American Heart Association.
Treatment Gap Identified in New Analysis
The study, conducted by Mustafa Al-Jarshawi and Mamas A. Mamas at Keele University in the United Kingdom and the University of Manchester, reveals that 28% of the 81 million U.S. adults with high blood pressure and no existing heart disease now qualify for pharmaceutical intervention. While 13.1 million of those eligible—representing 57%—already take blood pressure medication, a treatment gap leaves 9.7 million untreated, according to data drawn from the National Health and Nutrition Examination Survey collected between 2009 and 2018.
“Through this study, our goal was to understand how many people may qualify for treatment according to the updated recommendations in the guideline,” Al-Jarshawi says, noting the analysis also sought to estimate prevented mortality. The research links medication among eligible adults to a 23% lower risk of dying from any cause and a 50% reduction in heart-related deaths. Extending treatment to all 9.7 million untreated individuals could avoid roughly 200,000 deaths from all causes and about 162,000 cardiovascular deaths over a decade, the authors estimate.
Did you know? Adults who stood to gain the most from the updated thresholds were older, averaging 66 years of age, and frequently managed concurrent conditions such as diabetes and chronic kidney disease, according to the Keele University analysis.
PREVENT Equations Drive Risk Calculation
The 2025 guideline from the American Heart Association and the American College of Cardiology maintains lifestyle management as the central pillar of care. Diet, weight, activity, salt, and limited alcohol consumption remain the primary focus before clinicians add medication, which is determined when benefits outweigh risks.
The operational shift stems from how clinicians calculate risk. Doctors are directed to utilize the PREVENT equations, developed by the American Heart Association, to estimate a patient’s 10-year probability of cardiovascular disease for adults aged 30 to 79. A 10-year risk score below 7.5% is categorized as low.
“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,” says Daniel W. Jones, who chaired the committee that wrote the 2025 guideline and was not involved in the analysis. “The American Heart Association’s PREVENT risk equations help to identify individuals who could benefit from treatment before a major cardiac event.”
Lifestyle Remains First-Line Defense
Despite the broader net for medications, senior author Mamas emphasizes that pills are not the starting point for patients with mild elevations and low risk scores.
“Lifestyle modification remains the foundation of high blood pressure management,” Mamas states. “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.”
Research into specific physical activities demonstrates that aerobic exercise stands out as the sole workout type among eight evaluated in a head-to-head trial to lower blood pressure across a full 24-hour cycle. For individuals with readings under 140/90 mm Hg, no history of heart disease, stroke, chronic kidney disease, or diabetes, and a PREVENT score under 7.5%, lifestyle changes can delay or eliminate the need for drugs, according to Mamas.
Study Limitations and Clinical Conversations
The study’s authors highlight several methodological limitations. Blood pressure figures in the survey data relied on a single measurement visit, whereas official clinical guidelines demand multiple readings across separate appointments to prevent misclassification. Furthermore, treatment was not randomly assigned, meaning unobserved differences between treated and untreated groups could influence outcomes.
Jones notes that these population-level estimates do not dictate individual treatment plans. Instead, the numbers set the stage for clinical consultations. Healthcare professionals must evaluate overall patient risk profiles and collaborate on combining lifestyle strategies with medication, according to Jones.
Pro Tip for Patients
Do not rely on a single blood pressure reading taken on one day. Ask your doctor for serial measurements across multiple visits and a formal calculation of your 10-year cardiovascular risk using the PREVENT equations before making medication decisions.
Frequently Asked Questions
Who qualifies for blood pressure medication under the 2025 guidelines?
Adults with a reading of 130/80 mm Hg who have no diagnosed heart disease now qualify for medication evaluation, depending on their 10-year cardiovascular risk calculated via PREVENT equations.
What is the PREVENT risk score threshold?
A 10-year cardiovascular disease risk score below 7.5% is categorized as low for adults aged 30 to 79.
How many untreated Americans are affected by the new thresholds?
An analysis published in the Journal of the American Heart Association estimates that 9.7 million U.S. adults who meet the new treatment criteria are not currently taking blood pressure medication.
Are lifestyle changes still recommended first?
Yes. The American Heart Association and American College of Cardiology guidelines keep weight management, diet, physical activity, and sodium reduction at the center of initial care.
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