Nearly 23 million Americans qualify for the use of blood-pressure-lowering medications but many are missing out.

The figure is those with a blood pressure of 130/80 mm Hg or higher and as such may be eligible for blood-pressure-lowering medications based on the 2025 American Heart Association/American College of Cardiology guidelines.

The 2025 American Heart Association/American College of Cardiology High Blood Pressure guideline advises lifestyle changes – eating a healthy diet, managing weight, getting regular physical activity and reducing salt and alcohol – as a key part of treatment for high blood pressure, with medication prescribed if appropriate.

The guideline also suggests healthcare professionals use the American Heart Association’s PREVENT^TM (Predicting Risk of cardiovascular disease EVENTs) risk equations to calculate 10-year cardiovascular disease risk among adults (ages 30-79 without known cardiovascular disease) with high blood pressure who do not have established cardiovascular disease.

The latest study is one of the first detailed assessments of the 2025 guideline on high blood pressure and updated cardiovascular disease risk estimates using the PREVENT risk equations.

“Through this study, our goal was to understand how many people may qualify for treatment according to the updated recommendations in the guideline and estimate how many deaths from any cause and from cardiovascular disease may be prevented in the long term if the guideline recommendations were applied and untreated patients received care that included medication,” said study lead author Mustafa Al-Jarshawi, an academic clinical fellow in cardiology, member of the Cardiovascular Research Group at the Centre for Prognosis Research at Keele University in the United Kingdom and honorary research fellow at the Centre for Health Informatics, University of Manchester.

Researchers examined links between blood pressure treatments and rates of deaths from all causes and from cardiovascular conditions. Their analysis predicted how many lives may be saved if treatment plans outlined in the 2025 guideline were prescribed.

The data analysis found:

• 81 million U.S. adults had a diagnosis of high blood pressure. Of these, 22.8 million (28%) were guideline-eligible for therapy based on a blood pressure reading of 130/80 mm Hg or higher. 13.1 million (57%) adults were already receiving treatment for high blood pressure, while 9.7 million (43%) remained untreated. Please note: The blood pressure readings were measured during one office visit for the National Health and Nutrition Examination Survey (NHANES) collected between 2009 and 2018. The current guideline advises taking multiple readings during multiple office visits. This is an important study limitation.
• The analysis estimated that, among eligible adults, 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. This was compared to eligible adults who do not receive treatment.
• If treatment with medications was extended to all untreated but eligible adults, the analysis estimates approximately 200,000 all-cause deaths and 162,000 cardiovascular deaths may be prevented during the next decade.
• People eligible for high blood pressure treatment with medication who would benefit most were older, with an average age of 66, and had more health conditions, including diabetes, chronic kidney disease and other cardiovascular disease risk factors.

“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 said.

“Lifestyle modification remains the foundation of high blood pressure management. 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,” said study senior author Mamas A. Mamas, professor of cardiology at Keele University and honorary professor of Population Health at the University of Manchester. “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. Even if you do need medication to lower blood pressure, making lifestyle changes is important for effective treatment and overall health.”

Chair of the American Heart Association’s 2025 guideline writing committee Daniel Jones added: “Controlling blood pressure is crucial for long-term health. While lifestyle changes are the foundation for better overall health, people with high blood pressure and higher risk for cardiovascular disease may also need medication to reduce the risk of serious complications from untreated high blood pressure. Healthcare professionals should assess overall cardiovascular risk and work together with their patients to combine lifestyle strategies and medication for optimal blood pressure control.”