Nearly 10 million Americans with untreated high blood pressure could become eligible for blood pressure-lowering medication under updated US guidelines, according to a new study published in the Journal of the American Heart Association.
Researchers found that nearly one in three US adults with untreated hypertension could benefit from medication under the revised approach, potentially preventing hundreds of thousands of deaths over the next decade.
New guidelines expand treatment eligibility
The 2025 guidelines from the American Heart Association and American College of Cardiology place greater emphasis on a person's overall risk of cardiovascular disease when determining whether medication should be prescribed.
Doctors can use the American Heart Association's PREVENT calculator, which considers factors including blood pressure, blood sugar, kidney function and estimated 10-year cardiovascular risk.
Under the updated approach, as many as 81 million Americans with high blood pressure could be eligible for medication. Researchers estimate that around 9.7 million of the nearly 23 million untreated adults without existing cardiovascular disease could newly qualify for treatment.
Previously, people with blood pressure readings around 130/80 mmHg were often advised to focus primarily on lifestyle changes such as exercise and a healthier diet, depending on their overall cardiovascular risk.
The revised guidelines could lead doctors to recommend medication to more patients who have additional risk factors.
Earlier treatment could prevent thousands of deaths
Researchers analysed data from the National Health and Nutrition Examination Survey collected between 2009 and 2018.
They estimated what could have happened if the newer hypertension guidelines had been applied during that period.
According to the study, people eligible for medication 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 estimated to be about 50% lower.
Researchers calculated that broader treatment could prevent approximately 162,600 cardiovascular deaths and 200,900 deaths from all causes over 10 years.
People with diabetes could potentially benefit significantly, as the two conditions frequently occur together and can substantially increase the risk of cardiovascular disease.
Lifestyle changes remain important
Experts stressed that medication is only one part of managing high blood pressure.
Regular physical activity, a balanced diet, maintaining a healthy weight, managing stress and avoiding harmful substances can also help reduce cardiovascular risk.
Taking prescribed medication consistently is also important. A 2025 JAMA Cardiology study found that around half of US adults with high blood pressure do not take their medication regularly.
Doctors recommend simple strategies, such as keeping medication near a toothbrush or setting a daily reminder, to help patients avoid missed doses.
People experiencing side effects or struggling with their treatment should consult their doctor rather than stopping medication on their own.
Earlier treatment may reduce long-term risk
The study also highlights the importance of identifying cardiovascular risks early, particularly among younger adults with chronic conditions such as diabetes.
Researchers said combining appropriate medication with healthy lifestyle choices could help reduce the long-term risk of heart attacks, strokes and premature death.
However, treatment decisions should be made with a healthcare professional based on an individual's blood pressure readings, overall cardiovascular risk and other medical factors.
