A major new analysis suggests that many people with high blood pressure may not be receiving treatment even though they meet the latest medical recommendations.
The study, published in the Journal of the American Heart Association, examined the potential impact of the 2025 American Heart Association and American College of Cardiology blood pressure guideline.
High blood pressure is often called the “silent killer” because it usually causes no warning signs while gradually damaging blood vessels. Over time it greatly increases the risk of heart attack, stroke, heart failure and kidney disease.
The updated guideline recommends that doctors look beyond blood pressure numbers alone. Instead, they should also calculate a person’s future risk of cardiovascular disease using the PREVENT risk equations before deciding whether blood pressure medicine is needed.
Researchers analysed national U.S. health survey data to estimate how many adults would qualify for treatment. They found that of the 81 million adults with high blood pressure, nearly 23 million met the criteria for medication. More than four in ten of these eligible adults were not currently being treated.
People receiving medication had substantially lower risks of death than comparable untreated people. The analysis estimated a 23% lower risk of death from any cause and a 50% lower risk of cardiovascular death.
If all eligible untreated adults started appropriate blood pressure medication, researchers estimated that approximately 200,000 deaths from all causes and 162,000 cardiovascular deaths could potentially be prevented during the next 10 years.
Researchers also identified who might benefit most. Eligible adults were generally older and more likely to have diabetes, chronic kidney disease or several other risk factors for cardiovascular disease.
The guideline strongly emphasises that medication is only one part of treatment. Healthy eating, regular exercise, maintaining a healthy body weight, reducing salt intake, avoiding excessive alcohol, getting enough sleep and controlling stress remain the foundation of blood pressure management.
For people whose overall cardiovascular risk is low, lifestyle changes alone may initially be enough. However, those with higher long-term risk may need medication as well as healthy habits to achieve the greatest protection.
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.
The study highlights a significant treatment gap and suggests that better identification of high-risk patients could save many lives. Although the findings are based on modelling rather than a clinical trial, they provide strong support for personalised blood pressure care that combines lifestyle improvements with medication when appropriate.
If you care about high blood pressure, please read studies that early time-restricted eating could help improve blood pressure, and natural coconut sugar could help reduce blood pressure and artery stiffness.
For more health information, please see recent studies about How to eat your way to healthy blood pressure and results showing that Modified traditional Chinese cuisine can lower blood pressure.
