DALLAS / MIAMI — A sweeping new analysis published in the Journal of the American Heart Association (JAHA) has fundamentally redrawn the map of preventive cardiology in the United States, estimating that nearly 23 million American adults may now be clinically eligible for antihypertensive medication under the updated 2025 guidelines from the American Heart Association (AHA) and American College of Cardiology (ACC).

The epidemiological study, led by researchers at Keele University and the University of Manchester in the United Kingdom, marks one of the first comprehensive evaluations of the AHA’s newly implemented PREVENT (Predicting Risk of cardiovascular disease EVENTs) risk equations. By moving beyond isolated blood pressure readings and integrating a patient’s holistic 10-year cardiovascular risk profile, the findings suggest that millions of individuals with only moderately elevated blood pressure could vastly improve their longevity through pharmacological intervention.

The 23 Million Treatment Gap

The researchers analyzed data from the National Health and Nutrition Examination Survey (NHANES) spanning 2009 to 2018, focusing on 81 million U.S. adults diagnosed with hypertension but lacking established cardiovascular disease. Of this vast cohort, 22.8 million (28 percent) met the new threshold for medication therapy—defined as a blood pressure reading of 130/80 mm Hg or higher combined with specific risk factors.

However, the data revealed a glaring clinical void: while 13.1 million were already receiving treatment, nearly 9.7 million eligible individuals remained entirely untreated. "What stood out most was the size of the treatment gap—more than 40% of people who were clearly eligible under the new guideline were not receiving treatment, as well as the scale of the potential benefit," said study lead author Mustafa Al-Jarshawi, an academic clinical fellow in cardiology at Keele University.

If treatment with medications was extended to all untreated but eligible adults, the analysis estimates approximately 200,000 all-cause deaths and 162,000 cardiovascular deaths may be prevented during the next decade. — Journal of the American Heart Association, 2026

Beyond the Sphygmomanometer: The PREVENT Equation

Historically, the decision to prescribe blood pressure medication relied heavily on a binary threshold—typically 140/90 mm Hg, or 130/80 mm Hg for those with known comorbidities like diabetes. The 2025 AHA/ACC guidelines represent a paradigm shift, urging clinicians to utilize the PREVENT risk calculator. This tool synthesizes age, cholesterol levels, smoking status, kidney function, and other metabolic markers to predict a patient's 10-year risk of a major cardiac event.

The empirical modeling demonstrated that individuals who would benefit most from the newly expanded treatment criteria are generally older—averaging 66 years of age—and possess a higher burden of systemic conditions such as chronic kidney disease and dyslipidemia. For these patients, receiving blood pressure-lowering medications was associated with a 23 percent lower risk of dying from any cause and a staggering 50 percent lower risk of dying from heart-related issues.

Lifestyle Remains the Bedrock

Despite the push for broader pharmacological intervention, the study’s authors and the AHA remain steadfast in their emphasis on foundational lifestyle modifications. "Lifestyle modification remains the foundation of high blood pressure management," noted senior author Mamas A. Mamas, Professor of Cardiology at Keele University. "For many people, especially those with blood pressure under 140/90 mm Hg and no history of heart disease... lifestyle changes can be enough at first."

The clinical consensus remains that diet, exercise, sodium reduction, and stress management are the first line of defense. Medication is not a panacea but a vital adjunct for those whose holistic risk profile demands aggressive intervention to stave off silent killers like atherosclerosis.

Official Statement from Researchers

Keele University officially announced the findings on social media, highlighting the profound public health implications of closing the treatment gap. The original announcement is embedded below:

Offering high blood pressure treatment to more people could prevent around 200,000 deaths over the next decade, according to new research from @KeeleUniversity and @OfficialUoM. https://t.co/jZ5a6w8X5Y

— Keele University ????️ (@KeeleUniversity) July 30, 2026

Source: Read the full medical roundup at Baptist Health | AHA Official Newsroom Release