About 22.8 million US adults with high blood pressure and no known heart disease are newly eligible for blood pressure medication under the 2025 American Heart Association and American College of Cardiology guideline, and 9.7 million of them are not currently taking any, according to an analysis published July 29 in the Journal of the American Heart Association. The independent study, led by researchers at Keele University in England, used national survey data from 2009 to 2018 to estimate who the new thresholds capture.
Key takeaways
- Of 81 million US adults with a high blood pressure diagnosis, 22.8 million (28%) qualify for medication under the new guideline.
- Most of the newly eligible group is not new to the diagnosis. 13.1 million (57%) were already on treatment. The remaining 9.7 million (43%) were not.
- Researchers project roughly 200,000 all-cause deaths and 162,000 cardiovascular deaths could be prevented over the next decade if that untreated group were treated.
What the study found
The team applied the 2025 guideline’s rules to National Health and Nutrition Examination Survey data collected between 2009 and 2018, with eligibility set by a reading of 130/80 mm Hg or higher. Among 81 million adults with a high blood pressure diagnosis, 22.8 million (28%) were guideline-eligible for therapy. Of those, 13.1 million (57%) were already receiving treatment and 9.7 million (43%) were not.
When the researchers linked treatment status to death records, taking blood pressure medication was associated with about a 23% lower risk of dying from any cause and about a 50% lower risk of dying from a heart-related cause, compared with eligible adults who went untreated. Scaling that up, they estimated approximately 200,000 all-cause deaths and 162,000 cardiovascular deaths may be prevented during the next decade if the untreated eligible group received medication.
The people who stood to gain the most were older, with an average age of 66, and carried more other conditions, including diabetes and chronic kidney disease. The 2025 guideline also asks clinicians to run the American Heart Association’s PREVENT equations to calculate 10-year cardiovascular risk in adults ages 30 to 79 who have high blood pressure but no established heart disease.
Dr. Kumar’s take
The headline number invites a familiar complaint: a committee moved a line and 23 million people woke up as patients. That is not what this paper shows. Of the 22.8 million who now qualify, 13.1 million were already on medication. Their doctors had looked at them and decided to treat, guideline or not. The new threshold mostly caught up to practice.
The part that should hold your attention is the other 9.7 million, people whose numbers and risk profile made them clear candidates and who were getting nothing. That is an under-treatment story wearing an over-treatment costume. The lead author called the size of that gap the thing that stood out most, and I agree.
I would put a hard caveat on the deaths-prevented figure. Nobody was randomly assigned to treatment here. In the real world, the people who end up on blood pressure medication are the ones who show up to appointments, fill prescriptions, and have a doctor. Those same habits lower your risk of dying on their own. A 50% lower risk of cardiovascular death is a very large effect for a modest drop in blood pressure, and some of it almost certainly belongs to the healthier, more engaged patient rather than the pill.
Eligibility here also came from blood pressure measured at a single office visit, while the same 2025 guideline explicitly asks for multiple readings across multiple visits. One nervous afternoon in a clinic is not a diagnosis, and some share of these 22.8 million would fall back below the line on a second or third check at home. None of that makes the finding useless. It makes 200,000 a ceiling rather than a forecast.
What it means for you
If your reading has been sitting at or above 130/80, do not accept a single clinic number as final. Take readings at home, in the morning and evening, for a week, and bring the log to your doctor. That log is what the guideline actually wants.
Ask your clinician to calculate your PREVENT score. Blood pressure alone does not decide the medication question in the 2025 guideline. Your overall 10-year risk does, and the same reading means different things in a 45-year-old and a 66-year-old with diabetes. Nearly 9 in 10 US heart disease deaths are preventable, and this is one of the biggest levers you hold.
Lifestyle is not the consolation prize. The study’s senior author was blunt that weight, sodium, diet, activity, sleep, stress, and alcohol remain the foundation, and that people at lower risk can often stay off medication with those changes. Which exercises lower blood pressure the most over a full day? is a reasonable place to start, and a gentle Chinese exercise lowers blood pressure as well as brisk walking if a hard workout is not on the table.
And if you already know you are running high and nobody has treated it, you are one of the 9.7 million. That is the finding in this paper that should move you.