An independent study applying the 2025 American Heart Association/American College of Cardiology high blood pressure guideline to U.S. survey data estimated that 81 million U.S. adults have a diagnosis of high blood pressure. Of these, about 22.8 million (28%) would be newly eligible for blood-pressure-lowering medication using the guideline threshold of 130/80 mm Hg or higher.
Within the guideline-eligible group, 13.1 million (57%) were already receiving antihypertensive treatment and 9.7 million (43%) were untreated at the time of the data capture. The study linked receipt of medication to reduced mortality: a 23% lower risk of death from any cause and a 50% lower risk of death from cardiovascular causes in eligible adults who received medication compared with those who did not.
Modeling projected that if medications were extended to all untreated but eligible adults, approximately 200,000 all-cause deaths and 162,000 cardiovascular deaths could be prevented over the next decade according to the analysis reported.
The study incorporated the 2025 AHA/ACC guideline approach, which prioritizes lifestyle change and uses individualized cardiovascular risk assessment to determine the need for medication. Investigators used the American Heart Association’s PREVENT risk equations to estimate 10-year cardiovascular disease risk among adults aged 30–79 without known cardiovascular disease, consistent with the guideline recommendation to consider overall risk when deciding whether to add medication.
The analysis is described as one of the first detailed assessments combining the 2025 guideline thresholds with updated PREVENT risk estimates to quantify the number of people who would meet criteria for medical therapy.
Using the observed associations between treatment and outcomes, researchers estimated substantial potential benefits if untreated but eligible adults were treated with antihypertensive medications. The analysis indicated: a 23% lower risk of all-cause mortality and a 50% lower risk of cardiovascular mortality among treated versus untreated eligible individuals. When extrapolated to the U.S. population, the projection was that roughly 200,000 all-cause deaths and 162,000 cardiovascular deaths might be prevented in the next 10 years if treatment were extended to all untreated but guideline-eligible adults.
The study found that those who would benefit most from initiating medication were generally older (average age about 66) and had more comorbid conditions. Common coexisting conditions among participants included diabetes and chronic kidney disease, along with other cardiovascular risk factors. These higher-risk clinical profiles drove both eligibility for medication under guideline criteria and larger absolute benefit in modeled outcomes.
The 2025 guideline emphasizes lifestyle modification — including a heart-healthy diet, weight management, regular physical activity, sodium reduction, alcohol moderation, stress management and adequate sleep — as foundational therapy for high blood pressure. The guideline recommends using lifestyle measures initially, particularly for people with blood pressure under 140/90 mm Hg and low 10-year risk (PREVENT score under 7.5%), and adding medication when overall cardiovascular risk and blood pressure levels indicate it would be beneficial.
Study authors and guideline representatives reiterated that a personalized approach combining lifestyle interventions and medication when appropriate is central to reducing long-term cardiovascular risk.
The analysis used National Health and Nutrition Examination Survey (NHANES) data collected from 2009 to 2018. A key methodological limitation reported is that blood pressure measurements in NHANES were taken during a single office visit, whereas the clinical guideline recommends multiple readings across multiple visits to confirm diagnosis and treatment decisions. This single-visit measurement is noted as an important limitation that could affect estimated eligibility.
Other limitations included the observational, non-randomized nature of the data: treatment status was not randomly assigned, so unmeasured confounding could influence the observed associations between medication use and mortality. Medication use and treatment routines were assessed at one point in time; the study could not capture changes in therapy or adherence over time.
The findings highlight a substantial treatment gap: more than 40% of people who met guideline criteria for medication were not receiving drug therapy at the time of the survey. For clinicians, the study supports using risk-based assessment (for example, with the PREVENT equations) to identify patients who may need medication in addition to lifestyle measures. For patients, authors emphasized that lifestyle modification remains essential and may be sufficient for many with lower blood pressure and low risk, while those with higher overall cardiovascular risk may benefit from combined lifestyle and pharmacologic strategies.
Reported participant characteristics included 53% male and 47% female; 9.4% had chronic kidney disease; 17% had diabetes; 47% had dyslipidemia; and 15% were current smokers. Self-identified race/ethnicity breakdown was approximately 70% non-Hispanic White, 12% Black, 7.2% Mexican American, 5.8% multiracial and 4.2% other Hispanic adults. The press release notes that co-authors, disclosures and funding sources are listed in the published manuscript.
The analysis was published in the Journal of the American Heart Association. The press release provided links to the manuscript, AHA health information on high blood pressure and related lifestyle resources. The authors and AHA stress that the manuscript’s conclusions are those of the study authors and that the Association provides links to disclosures and funding details in the published paper.