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

Fig. 1. Proportion of US adults eligible for initiating or intensifying pharmacological treatment of hypertension according to the 2017 and 2025 AHA/ACC guidelines. Bars represent estimated proportions and error bars represent 95 % confidence intervals. For the 2025 guidelines, two sets of estimates depending on whether adults with a low PREVENT-based 10-year risk (i.e., <7.5 %) and stage 1 hypertension are able to sufficiently reduce blood pressure to below 130/80 mm Hg.

Fig. 2. Proportion of concordant & discordant class I recommendations for initiating pharmacological treatment according to the 2025 and 2017 AHA/ACC guidelines. Panels A and B contrast eligibility proportions by each guideline across the spectrum of age and body mass index (BMI), respectively. The shaded area in both panels depicts the weighted distribution of both variables. Panel C shows differences in eligibility between 2025 (assuming insufficiency of lifestyle modification for low-risk stage 1 hypertension) and 2017 across the spectrum of age and BMI. Panel A: Eligibility across the spectrum of age, Panel B: Eligibility across the spectrum of BMI, Panel C: Differences between the 2025 and 2017 across the combined spectra of age and BMI.

Fig. 3. Blood pressure control among US adults being treated for hypertension according to the 2025 AHA/ACC guidelines. Higher 10-year risk is determined by a predicted risk ≥7.5 % by PREVENT. These data exclude patients with established cardiovascular disease (defined as MI, stroke, CAD, or HF) and chronic kidney disease (defined as an ≤60 mL/min/1.73 m² or a urine albumin-creatinine ratio ≥30mg/g), as the 2025 guidelines do not explicitly endorse treatment intensification with a goal of <120/80 mmHg in these subgroups.