Blood pressure medication guidelines 2025 could apply to 23 million adults

Blood pressure medication guidelines 2025 criteria could make nearly 23 million U.S. adults eligible for drug treatment, according to independent research published in the Journal of the American Heart Association. The analysis matters because researchers estimated that treating eligible adults who are not now receiving medication could prevent deaths over the next decade.

The study examined the potential effect of the 2025 American Heart Association/American College of Cardiology high blood pressure guideline, which uses blood pressure levels and cardiovascular risk to guide treatment decisions. The guideline says lifestyle steps remain central to care and that medication should be used when appropriate.

Researchers reported that 81 million U.S. adults had high blood pressure. Among them, 22.8 million, or 28%, met medication-eligibility criteria based on blood pressure of 130/80 mm Hg or higher under the guideline.

Who may need blood pressure medication under the 2025 guidelines?

Under the 2025 guideline, adults with high blood pressure may be assessed for medication using blood pressure readings and their risk of cardiovascular disease. The guideline recommends the American Heart Association’s PREVENT risk equations for adults ages 30 to 79 who have high blood pressure and no known cardiovascular disease, according to the association.

PREVENT stands for Predicting Risk of cardiovascular disease EVENTs. The equations estimate a person’s 10-year cardiovascular disease risk, helping clinicians decide which patients may benefit from treatment before a major cardiac event, according to Daniel W. Jones, chair of the guideline writing committee.

The study found that 13.1 million eligible adults, or 57%, were already taking blood-pressure-lowering drugs. Another 9.7 million eligible adults, or 43%, were not receiving such treatment, according to the analysis.

Mustafa Al-Jarshawi, the study’s lead author and an academic clinical fellow in cardiology at Keele University in the United Kingdom, said the research aimed to estimate how many people would qualify for treatment and how many deaths might be avoided if untreated eligible patients received care that included medication.

What did the study estimate about deaths?

Among adults who met the guideline criteria, use of blood-pressure-lowering medication was associated with a 23% lower risk of death from any cause and a 50% lower risk of death from cardiovascular causes compared with eligible adults who were not treated, the researchers reported.

If medication treatment reached all adults who were eligible but untreated, the study estimated that about 200,000 deaths from all causes and 162,000 cardiovascular deaths could be prevented over 10 years.

The adults expected to benefit most from medication were older, with an average age of 66, and more likely to have other health conditions or risk factors. The study identified diabetes, chronic kidney disease and other cardiovascular disease risk factors among the conditions seen in this higher-benefit group.

What role do lifestyle changes play?

The 2025 guideline advises lifestyle changes as a core part of high blood pressure treatment, including a healthy diet, weight management, regular physical activity, and reductions in salt and alcohol. Mamas A. Mamas, the study’s senior author and a cardiology professor at Keele University, said lifestyle measures can lower blood pressure and overall cardiovascular risk.

According to Mamas, lifestyle changes may be enough at first for many people, especially those with blood pressure below 140/90 mm Hg and no history of heart disease, stroke, chronic kidney disease or diabetes. He said people with a 10-year heart disease risk below 7.5% on the PREVENT score may be able to delay or avoid medication by maintaining healthy habits.

The researchers noted a limitation: blood pressure values came from a single office visit in National Health and Nutrition Examination Survey data collected from 2009 through 2018. The current guideline calls for multiple readings across multiple office visits.

Jones, who was not involved in the study and is dean and professor emeritus at the University of Mississippi School of Medicine, said clinicians should assess overall cardiovascular risk and work with patients on both lifestyle strategies and medication when needed for blood pressure control.

This story draws on original reporting from Medical Xpress.