# Implications of the 2025 AHA/ACC high blood pressure guidelines on the initiation and intensification of blood pressure-lowering medications among US adults

## TL;DR

New blood pressure guidelines may lead to more US adults starting or intensifying blood pressure medications, especially younger and obese individuals.

## Contribution

Quantifies how updated hypertension guidelines affect treatment eligibility for millions of US adults.

## Key findings

- 2025 guidelines may expand medication eligibility for 19.4 million additional adults if lifestyle changes fail.
- Younger adults (30–60) and those with obesity show the largest increase in treatment eligibility.
- Over half of currently treated adults do not meet the new preferred blood pressure target.

## Abstract

Recent updates to the American College of Cardiology (ACC) and American Heart Association (AHA) guidelines for high blood pressure (BP) changed the risk calculator recommended, lowered the preferred treatment target, and expanded treatment recommendations for lower risk adults. We sought to quantify the clinical implications of these change among US adults.

Using data from the 2015–2020 National Health and Nutrition Examination Survey (NHANES), we estimated the proportion and number of US adults aged 20 years or older who were eligible for initiation or intensification of pharmacological anti-hypertensive medications under the 2017 vs the 2025 guidelines.

Among US adults ≥20 years not being currently treated for hypertension (N = 180.0 million), using the 2017 Guideline, 18.7 % (33.6 million) were eligible for initiation of pharmacological anti-hypertensive therapy. In contrast, the 2025 Guideline would treat 18.4 % (33.2 million) with upfront medication while an additional 10.8 % (19.4 million) would be considered for medications if lifestyle modification proves insufficient. Increases in treatment eligibility were most pronounced among younger adults age 30–60 and those with obesity. Among adults currently being treated for hypertension (N = 58.0 million), most (59.8 %; 34.6 million) did not meet the recommended goal of a BP <130/80. An additional 17.6 % (5.6 million) are newly eligible for treatment intensification if pursuing the preferred BP target of <120/80.

The new 2025 AHA/ACC Hypertension Guidelines potentially expands the number of adults eligible for initiation of antihypertensives, particularly in persons who are young and/or obese, and markedly expands number eligible for intensification.

Image, graphical abstract