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

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