Nearly 23 Million U.S. Adults May Need Blood Pressure Medication Under New Guideline

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 under the 2025 American Heart Association/American College of Cardiology High Blood Pressure guideline. The research, conducted by scientists at Keele University and the University of Manchester, analyzed data from 81 million U.S. adults with high blood pressure and no cardiovascular disease. Among them, 22.8 million (28%) were guideline-eligible for therapy based on a blood pressure reading of 130/80 mm Hg or higher. Of these, 13.1 million (57%) were already receiving treatment, while 9.7 million (43%) remained untreated.

The 2025 guideline emphasizes a personalized approach, recommending lifestyle changes—such as a healthy diet, weight management, regular physical activity, and reduced salt and alcohol intake—as foundational, with medication prescribed based on cardiovascular risk assessed using the American Heart Association’s PREVENT risk equations. The study is one of the first to assess the guideline’s impact using these updated risk estimates.

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. Extending treatment to all untreated eligible adults could prevent approximately 200,000 all-cause deaths and 162,000 cardiovascular deaths over the next decade. Lead author Mustafa Al-Jarshawi highlighted the treatment gap, noting that more than 40% of eligible individuals were not receiving medication, underscoring the potential benefit of closing this gap.

Study senior author Mamas A. Mamas emphasized that lifestyle modification remains crucial, but for those with higher risk, medication may be necessary. He noted that for individuals with blood pressure under 140/90 mm Hg and no history of heart disease, lifestyle changes may suffice initially, especially if their 10-year risk (PREVENT score) is under 7.5%. Daniel W. Jones, chair of the guideline writing committee, stressed the importance of controlling blood pressure for long-term health and encouraged healthcare professionals to assess overall cardiovascular risk and combine lifestyle strategies with medication for optimal management.

The study’s limitations include blood pressure measured during a single office visit, whereas the guideline recommends multiple readings. Despite this, the findings have significant implications for public health, highlighting the need for increased awareness and treatment access. For Texas, where high blood pressure affects millions, this research underscores the importance of proactive healthcare and risk assessment to prevent cardiovascular events and improve quality of life.