July 31, 2026Open Access
View Full PaperPopulation‐Level 10‐Year Implications of the New 2025 American Heart Association/American College of Cardiology Hypertension Guideline Recommendations for Primary Prevention in the United States: A NHANES‐Based Cohort Study (2009–2018)
Key Result
Antihypertensive therapy in guideline-eligible adults was associated with reduced all-cause mortality (HR 0.77; 95% CI 0.63-0.94) and cardiovascular mortality (HR 0.50; 95% CI 0.36-0.68).
Key Points
- This study aims to evaluate the population-level impact of the 2025 hypertension guidelines on treatment eligibility and mortality.
- Analyzed NHANES data from 2009 to 2018 linked to mortality until 2019.
- Included hypertensive adults without baseline cardiovascular disease.
- Used Cox models and simulation analyses to estimate treatment-related mortality outcomes.
- 28% of hypertensive adults were eligible for therapy under new guidelines; 57% of these were treated.
- Antihypertensive therapy was associated with a 23% reduction in all-cause mortality (HR, 0.77 [95% CI, 0.63-0.94]).
- Projected prevention of ~200,900 all-cause and ~162,600 cardiovascular deaths over 10 years with universal treatment.
Study Design
Type
Cohort
Multicenter
Yes
Structured PICO
Does antihypertensive therapy reduce all-cause and cardiovascular mortality in hypertensive adults eligible under the 2025 AHA/ACC guidelines?
P
Population
A nationally representative cohort representing 81.0 million US adults with hypertension and without baseline cardiovascular disease, linked to mortality data through 2019.
E
Exposure
Antihypertensive therapy according to 2025 AHA/ACC hypertension guidelines (advised at blood pressure ≥130/80 mm Hg in adults with diabetes, chronic kidney disease, or PREVENT 10-year CVD risk ≥7.5%).
C
Comparator
No antihypertensive therapy (untreated).
O
Outcome
All-cause mortality and cardiovascular mortality.hard clinical
Applying the 2025 AHA/ACC hypertension guidelines to treat eligible US adults could prevent over 200,000 all-cause and 160,000 cardiovascular deaths over a decade.
Main Result
Hazard Ratio: 0.77 (95% CI 0.63–0.94)
Abstract
BACKGROUND: In August 2025, the American Heart Association and American College of Cardiology released updated hypertension guidelines. Under the new guidelines, therapy is advised at blood pressure ≥130/80 mm Hg in adults with diabetes, chronic kidney disease, or a Predicting Risk of Cardiovascular Disease Events-estimated 10-year cardiovascular disease risk ≥7.5%. The long-term population-level changes following these guidelines remains uncertain. METHODS: We analyzed NHANES (National Health and Nutrition Examination Survey) 2009 to 2018 data linked to mortality through 2019. Hypertensive adults without baseline cardiovascular disease were included. Treatment eligibility was defined using guideline criteria. Cox models estimated associations between antihypertensive therapy and all-cause and cardiovascular mortality. Simulation analyses projected lives saved under full and partial treatment uptake. RESULTS: The weighted cohort represented 81.0 million US adults with hypertension. Of these, 22.8 million (28%) were guideline eligible for therapy; 13.1 million (57%) were treated, and 9.7 million (43%) remained untreated. Antihypertensive therapy was associated with a 23% reduction in all-cause mortality (hazard ratio HR, 0.77 95% CI, 0.63-0.94) and 50% reduction in cardiovascular mortality (HR, 0.50 95% CI, 0.36-0.68). At 10 years, universal treatment of eligible but untreated adults was projected to prevent ~200 900 all-cause and ~ 162 600 cardiovascular deaths. Benefits were greatest in adults with diabetes. CONCLUSIONS: In this nationally representative cohort, nearly 1 in 3 US adults with hypertension were newly eligible for therapy under the guideline, yet >2 in 5 remained untreated. Extending treatment to all eligible adults could prevent >200 000 all-cause and 160 000 cardiovascular deaths over the next decade.
Expert Takes3 quotes
1/3
“The 2025 guideline emphasizes a personalized approach to managing high blood pressure by considering blood pressure levels plus 10-year and 30-year overall cardiovascular disease risk. The American Heart Association's PREVENT risk equations help to identify individuals who could benefit from treatment before a major cardiac event. Controlling blood pressure is crucial for long-term health.”
Dr. Daniel W. Jones, Chair of the American Heart Association's 2025 guideline writing committeeUniversity of Mississippi School of Medicinegemini_groundedView source