Dr. Mustafa Al-Jarshawi was struck by two numbers while studying how new blood pressure guidelines might affect Americans. The first: more than 40 percent of people clearly eligible for treatment were not receiving it. The second: the enormous potential to change that. "What stood out most was the size of the treatment gap, as well as the scale of the potential benefit," said Al-Jarshawi, a cardiology researcher at Keele University in the United Kingdom.
High blood pressure, sometimes called the "silent killer" because it often has no symptoms, affects tens of millions of Americans and raises the risk of heart attacks and strokes. New 2025 guidelines from the American Heart Association and American College of Cardiology updated how doctors should identify and treat the condition.
Researchers examined how these new recommendations might reach more people. They analyzed data from the National Health and Nutrition Examination Survey, a large government health study, and published their findings in the Journal of the American Heart Association.
The numbers were striking. Of the 81 million American adults already diagnosed with high blood pressure, 22.8 million met the criteria for medication under the new guidelines. Of those, 13.1 million were already getting treatment. But 9.7 million were not — despite being eligible.
The study then asked a simple but powerful question: what if those untreated people got the medication they needed?
The answer: approximately 200,000 deaths from any cause and 162,000 deaths from heart-related causes could be prevented over the next decade, the researchers estimated. Among those already on medication, the treatment was linked to a 23 percent lower risk of dying from any cause and a 50 percent lower risk of dying from heart-related problems, compared with untreated eligible adults.
The people who stood to benefit most tended to be older, with an average age of 66, and often had other health conditions like diabetes or chronic kidney disease.
Dr. Mamas Mamas, a senior author of the study and professor at Keele University, emphasized that medication works best alongside healthy habits. "Lifestyle modification remains the foundation of high blood pressure management," he said. Eating a heart-healthy diet, exercising regularly, reducing salt, maintaining a healthy weight, and limiting alcohol can all help lower blood pressure.
The researchers acknowledged a key limitation: blood pressure readings in the data came from a single doctor visit, while current guidelines recommend taking multiple readings across several visits to confirm a diagnosis. Still, the findings point to a clear opportunity: closing the gap between who could benefit from treatment and who actually receives it.
"Our goal was to understand how many people may qualify for treatment and estimate how many deaths may be prevented if the guideline recommendations were applied," Al-Jarshawi said. The answer, it turns out, is hundreds of thousands of lives.