Key Takeaway:
- Nearly 10 million U.S. adults with high blood pressure may newly qualify for medication under updated guidelines.
- Treatment was associated with 23% lower overall death risk and 50% lower cardiovascular death risk.
- Experts stress that medication and lifestyle changes both play key roles in controlling blood pressure.
Nearly 10 million U.S. adults with high blood pressure may now qualify for Blood Pressure Drugs under updated 2025 guidelines, a July 29 study says, because risk-based treatment expands beyond blood pressure alone.
New guidelines expand treatment eligibility
The study, published in the Journal of the American Heart Association, examined how the American Heart Association and American College of Cardiology’s 2025 hypertension guidelines could change treatment eligibility.
Researchers analyzed National Health and Nutrition Examination Survey data collected from 2009 to 2018. Among an estimated 81 million U.S. adults with high blood pressure and no cardiovascular disease, about 22.8 million could qualify for medication under the updated recommendations.
Of those newly eligible adults, about 13.1 million were already receiving treatment, while 9.7 million were not. The study found that receiving Blood Pressure Drugs was associated with a 23% lower risk of death from any cause and a 50% lower risk of cardiovascular death, underscoring the value of comprehensive cardiovascular health strategies in managing hypertension.
“We estimated that approximately 200,900 all-cause deaths and 162,600 cardiovascular deaths could be prevented over the next 10 years,” said lead author Dr. Mustafa Al-Jarshawi, a cardiologist at Keele University in England.
Researchers link treatment to lower death risk
The updated guidelines emphasize more than a single blood pressure reading. Doctors can use the American Heart Association’s PREVENT risk equations, which estimate cardiovascular risk using factors including blood pressure, blood sugar and kidney function.
The guidelines generally emphasize lifestyle measures, including a healthy diet, regular physical activity, weight management and reducing salt and alcohol. Medication can be added when a person’s blood pressure and overall cardiovascular risk warrant treatment.
Cardiologist Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health in Denver, said the findings show why doctors may need to treat some patients more aggressively.
“What this is saying is that people who have traditionally not been at very high risk are now eligible to be treated with medications more aggressively,” Freeman said.
Freeman, who was not involved in the study, said high blood pressure can increase risks associated with other chronic conditions. “Generally, I think when people have additional risk, blood pressure is really the silent killer,” he said.
Lifestyle changes still matter
Researchers say medication should complement, rather than replace, healthy lifestyle habits. The study also found that adults with diabetes could benefit substantially from treatment because diabetes and high blood pressure often occur together and raise cardiovascular risk.
Dr. Leana Wen, an emergency physician and adjunct associate professor at George Washington University, has advised people to focus on physical activity, diet, substance use, stress, and maintaining a healthy weight.
“You don’t have to do everything perfectly to make a difference in your health,” Wen said, encouraging people to begin with manageable changes.
Freeman also emphasized that prescribed medication only helps when patients take it consistently, a point reinforced by the American Heart Association’s own guideline announcement. He recommends linking medication with an existing daily routine, such as brushing teeth or responding to a morning alarm.
The study has limitations. Researchers relied on blood pressure measurements collected during one visit in the older survey data, while current guidelines recommend multiple readings during multiple visits before prescribing Blood Pressure Drugs.
