Nearly 10 Million Americans With Untreated High Blood Pressure Could Benefit From Medication Under New Guidelines
核心洞察
A new study finds nearly 1 in 3 U.S. adults with untreated high blood pressure (搜索) would benefit from medication but are not receiving it, totaling roughly 9.7 million people.
Applying the 2025 AHA/ACC PREVENT tool, about 81 million Americans would be eligible for blood pressure medication, with nearly 23 million newly eligible under updated guidelines.
Treatment was associated with a 23% lower risk of all-cause death and a 50% lower risk of cardiovascular death, with adults with diabetes (搜索) benefiting most.
Nearly 1 in 3 adults in the United States with untreated high blood pressure (搜索) would benefit from treatment and are not getting it, according to a new study published July 29 in the Journal of the American Heart Association. The analysis found that nearly 10 million Americans now meet newly updated guidelines by the American Heart Association and American College of Cardiology (搜索) that redefine an adult's risk for cardiovascular disease (搜索).
"We estimated that approximately 200,900 all-cause deaths and 162,600 cardiovascular deaths could be prevented over the next 10 years," said lead study author Dr. Mustafa Al-Jarshawi, a cardiologist at Keele University in England.
The study analyzed National Health and Nutrition Examination Survey data from 2009 to 2018. Newer data is available, but the most up-to-date version of the survey has not been available long enough for researchers to know participants' cause and time of death. The study examines how death rates might be lower if the 2025 hypertension guidelines were implemented during those years, Al-Jarshawi said.
Redefining Risk With the PREVENT Tool
Ideally, doctors want blood pressure to fall below 120 mmHg systolic and 80 mmHg diastolic. If blood pressure is around 130/80, doctors have typically advised people to make lifestyle changes, such as increasing exercise. However, the updated guideline recommends that doctors look beyond blood pressure numbers alone, calculating a person's future risk of cardiovascular disease (搜索) using the PREVENT risk equations before deciding whether blood pressure medicine is needed.
If doctors use the American Heart Association's new PREVENT tool, which considers blood sugar, kidney function and a person's decade-long risk for heart disease as well as blood pressure, some 81 million Americans would be eligible for blood pressure medications.
"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," said cardiologist Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health in Denver.
Among 81 million adults with high blood pressure (搜索) and no cardiovascular disease (搜索), nearly 23 million may be newly eligible under the new guidelines. Of those 23 million, 9.7 million were untreated.
Expanding Treatment Could Save Lives
Becoming eligible to receive blood pressure medication was associated with a 23% lower risk of dying compared with no treatment. When it comes to the chances of dying from a heart-related issue, risk dropped by 50%. The study also found that adults with diabetes (搜索) would benefit most from treatment, because diabetes and high blood pressure (搜索) often occur together, significantly increasing cardiovascular risk, Al-Jarshawi said.
Eligible adults were generally older and more likely to have diabetes (搜索), chronic kidney disease (搜索) or several other risk factors for cardiovascular disease (搜索). High blood pressure (搜索) is often called the "silent killer" because it usually causes no warning signs while gradually damaging blood vessels, and over time it greatly increases the risk of heart attack, stroke, heart failure and kidney disease.
"Generally, I think when people have additional risk, blood pressure is really the silent killer," said Freeman, who was not involved with the study.
Treatment Is More Than a Medication
Any eligible person should not hesitate to start taking medication in addition to making lifestyle changes to reduce long-term risks, Al-Jarshawi said. The guideline strongly emphasizes that medication is only one part of treatment, with healthy eating, regular exercise, maintaining a healthy body weight, reducing salt intake, avoiding excessive alcohol, getting enough sleep and controlling stress remaining the foundation of blood pressure management.
"The western world is ailing from a variety of cardiometabolic, kidney diseases," Freeman said. "High blood pressure (搜索) amplifies a lot of risk, and we have to do whatever we can to get that risk down and being aggressive about blood pressure is very low-hanging fruit."
However, medication only works when it is inside the person, and not sitting in the bottle unused, Freeman said. About half of adults in the US with high blood pressure (搜索) do not regularly take their prescribed medication, according to a July 2025 study published in the journal JAMA Cardiology. Freeman recommends forming a habit, such as keeping a pillbox next to an alarm or toothbrush, or carrying a small supply in a purse, wallet or car.
The study's findings also highlight the need for physicians to be alert to early signs of disease and consider blood pressure treatment, even in younger people, according to Freeman. "We're seeing a lot more young people now who have chronic disease and diabetes (搜索) and other things that may be relatively mild, but still at risk, and we need to be even more aggressive," Freeman said.
Study Limitations
The researchers caution that their estimates have limitations because blood pressure measurements came from a single clinic visit rather than repeated readings, which are recommended before diagnosing hypertension. Although the findings are based on modeling rather than a clinical trial, they provide strong support for personalized blood pressure care that combines lifestyle improvements with medication when appropriate.