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Population-Level 10-Year Implications of the New 2025 American Heart Association/American College of Cardiology

Mustafa Al-Jarshawi1,2, Sripal Bangalore3, Harindra C Wijeysundera4,5,6,7

  • 1Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health University of Manchester Manchester UK.

Journal of the American Heart Association
|July 29, 2026
PubMed

Insights

New hypertension guidelines could save over 200,000 lives. Treating eligible adults with high blood pressure significantly reduces mortality, especially for those with diabetes.

Area of Science:

  • Cardiology
  • Public Health
  • Epidemiology

Background:

  • Updated hypertension guidelines were released in August 2025 by the American Heart Association and American College of Cardiology.
  • Therapy is recommended for adults with blood pressure ≥130/80 mmHg, particularly those with diabetes, chronic kidney disease, or a high estimated cardiovascular disease risk.
  • The long-term impact of these guidelines on a population level remains unclear.

Purpose of the Study:

  • To assess the impact of the updated hypertension guidelines on mortality.
  • To determine the proportion of eligible adults receiving treatment.
  • To project the potential lives saved by extending treatment to all eligible individuals.

Main Methods:

  • Analysis of National Health and Nutrition Examination Survey (NHANES) data from 2009-2018, linked to mortality data through 2019.
  • Inclusion of hypertensive adults without pre-existing cardiovascular disease.
  • Use of Cox models to estimate the association between antihypertensive therapy and mortality, and simulation analyses for projected lives saved.

Main Results:

  • The study included 81.0 million US adults with hypertension; 22.8 million (28%) were eligible for therapy.
  • Of eligible adults, 13.1 million (57%) were treated, while 9.7 million (43%) remained untreated.
  • Antihypertensive therapy showed a 23% reduction in all-cause mortality and a 50% reduction in cardiovascular mortality. Universal treatment could prevent approximately 200,900 all-cause and 162,600 cardiovascular deaths over 10 years, with the greatest benefits observed in adults with diabetes.

Conclusions:

  • Nearly one-third of US adults with hypertension became eligible for treatment under the new guidelines, yet over 40% remained untreated.
  • Extending treatment to all eligible adults has the potential to prevent over 200,000 all-cause deaths and 160,000 cardiovascular deaths within a decade.
  • The findings highlight a significant opportunity to improve cardiovascular health outcomes through guideline-based hypertension management.
Abstract

Keywords:
2025 AHA/ACC guidelinesNHANESPREVENT risk scoreantihypertensive therapycardiovascular mortalityhypertensionprimary prevention

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