New U.S. Hypertension Guidelines Could Expand Treatment to Nearly 10 Million More Adults, Study Finds

A new study published in the Journal of the American Heart Association suggests that nearly 10 million U.S. adults with untreated high blood pressure could become eligible for medication under updated clinical guidelines, potentially preventing hundreds of thousands of premature deaths over the next decade.

Researchers found that roughly one in three adults with untreated hypertension could benefit from the revised recommendations. Physicians say widespread implementation of the new guidelines could significantly reduce deaths linked to cardiovascular disease.

The 2025 guidelines, issued jointly by the American Heart Association (AHA) and the American College of Cardiology (ACC), place greater emphasis on a patient's overall cardiovascular risk when determining whether blood pressure medication should be prescribed.

Under the updated approach, clinicians are encouraged to use the AHA's PREVENT risk calculator, which evaluates blood pressure, blood sugar, kidney function, and an individual's estimated 10-year risk of cardiovascular disease to guide treatment decisions.

The study estimates that about 81 million Americans with hypertension would qualify for medication under the new framework. Among the 23 million untreated adults with high blood pressure but no previous cardiovascular disease, approximately 9.7 million would become newly eligible for drug therapy.

Previously, people with blood pressure readings around 130/80 mmHg and no history of cardiovascular disease were generally advised to manage their condition through lifestyle changes, such as improving their diet and increasing physical activity. The revised guidelines make it easier for higher-risk patients to receive medication earlier.

Researchers analyzed data from the National Health and Nutrition Examination Survey (NHANES) collected between 2009 and 2018 to estimate how the updated recommendations might have affected patient outcomes if they had been in place during that period.

The analysis found that adults who received blood pressure medication after becoming eligible had an estimated 23% lower risk of death from any cause compared with those who remained untreated. Their risk of dying from cardiovascular disease was reduced by about 50%.

According to the researchers' projections, broader use of the updated treatment strategy could prevent approximately 162,600 cardiovascular deaths and 200,900 premature deaths from all causes over a 10-year period.

The study suggests that people with diabetes could benefit particularly from the revised approach, as the combination of diabetes and high blood pressure substantially increases the risk of heart disease.

Health experts emphasized that medication alone is not enough to control hypertension. Regular exercise, a balanced diet, maintaining a healthy weight, reducing stress, and avoiding harmful habits such as smoking remain essential components of cardiovascular disease prevention.

They also stressed the importance of taking prescribed medications consistently. A separate study published in JAMA Cardiology found that nearly half of U.S. adults with hypertension do not take their medications regularly. Physicians recommend practical strategies such as keeping medication next to a toothbrush or setting daily reminders to improve adherence. Patients experiencing side effects are advised to consult their healthcare provider rather than stopping medication on their own.

Researchers also highlighted the importance of identifying cardiovascular risk early, particularly among younger adults and those living with chronic conditions such as diabetes.

They concluded that combining healthy lifestyle habits with appropriate medication, when indicated, can substantially reduce the long-term risk of stroke, heart attack, and premature death. Treatment decisions, however, should always be individualized based on blood pressure levels, overall health risks, and a physician's clinical judgment.