A new independent study published today in the Journal of the American Heart Association reveals that nearly 23 million U.S. adults with high blood pressure may be newly eligible for blood-pressure-lowering medications under the 2025 American Heart Association/American College of Cardiology guideline. The study, which is one of the first detailed assessments of the updated guideline, analyzed data from 81 million U.S. adults with high blood pressure and no cardiovascular disease. Of these, 22.8 million (28%) were found to be guideline-eligible for therapy based on a blood pressure reading of 130/80 mm Hg or higher.
The 2025 guideline recommends lifestyle changes as a key part of treatment, with medication prescribed if appropriate. It also encourages healthcare professionals to use the American Heart Association's PREVENT risk equations to calculate 10-year cardiovascular disease risk for adults aged 30-79 without known cardiovascular disease. This study examined the potential impact of applying these recommendations, focusing on the treatment gap and potential lives saved.
Among the 22.8 million eligible adults, 13.1 million (57%) were already receiving treatment, while 9.7 million (43%) remained untreated. The analysis estimates 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 did not receive treatment. If treatment were extended to all untreated but eligible adults, the study estimates approximately 200,000 all-cause deaths and 162,000 cardiovascular deaths could be prevented over the next decade.
“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 findings underscore the importance of combining lifestyle changes with medication for effective blood pressure management. “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. 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.”
Chair of the 2025 guideline writing committee Daniel W. Jones, M.D., FAHA, who was not involved in the study, emphasized the personalized approach: “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. The American Heart Association’s PREVENT risk equations help to identify individuals who could benefit from treatment before a major cardiac event.”
The study also highlighted that people eligible for treatment who would benefit most were older, with an average age of 66, and had more health conditions such as diabetes, chronic kidney disease, and other cardiovascular risk factors. Among the study participants, 9.4% had chronic kidney disease, 17% had diabetes, 47% had dyslipidemia, and 15% were current smokers.
Study limitations include that blood pressure was measured during a single office visit, whereas the guideline advises multiple readings over multiple visits. Additionally, researchers did not randomly assign treatment, so unmeasured factors may have influenced results. Despite these limitations, the study provides compelling evidence for the potential impact of the 2025 guideline on public health.
For business and technology leaders, this research underscores the growing intersection of data-driven risk assessment tools like PREVENT and personalized medicine. The ability to predict cardiovascular risk and tailor treatment accordingly not only improves patient outcomes but also has significant implications for healthcare costs and resource allocation. As AI and predictive analytics continue to evolve, such tools could become standard in preventive care, reshaping how chronic conditions are managed.
The study was published in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.
