{
  "abstract": "BACKGROUND: Hypertension is a major risk factor for cardiovascular disease. Adoption of the Predicting Risk of Cardiovascular Disease Events risk model in the 2025 American College of Cardiology/American Heart Association guideline may substantially alter the number and characteristics of adults with untreated stage 1 hypertension who are recommended for treatment. We aimed to quantify treatment-recommendation reclassification among adults with untreated stage 1 hypertension under the 2025 Predicting Risk of Cardiovascular Disease Events-based guideline compared with the 2017 pooled cohort equations-based guideline. METHODS: This cross-sectional, nationally representative study used data from NHANES (National Health and Nutrition Examination Survey) 2015 to March 2020. The study population included adults aged 30 to 79 years with stage 1 hypertension, focusing on untreated participants. The exposure was the guideline-endorse cardiovascular risk assessment framework, pooled cohort equations, and Predicting Risk of Cardiovascular Disease Events, respectively. The primary outcome was recommendation for antihypertensive pharmacotherapy. RESULTS: Among 1926 adults with stage 1 hypertension (weighted 32.57 million), 59.59% (19.41 million) were untreated. Under the 2025 guideline, 13.84% (95% CI, 7.06%-20.63%) of untreated adults eligible under the Predicting Risk of Cardiovascular Disease Events threshold (0.42 million) became newly eligible for pharmacotherapy compared with the 2017 guideline. Newly eligible adults were older (mean±SE, 60.48 [0.77] years) and had higher diabetes prevalence (37.74% [95% CI, 15.45%-60.04%]) than those below the treatment threshold. CONCLUSIONS: The 2025 American College of Cardiology/American Heart Association hypertension guideline recommendations were largely concordant with the prior guideline among adults with untreated stage 1 hypertension, while still newly identifying a subset of individuals with elevated cardiometabolic risk who may benefit from earlier intervention.",
  "abstract_shown": true,
  "affiliations": [
    "University of Florida",
    "Northwestern University Feinberg School of Medicine"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Qi Jian",
      "orcid": "0009-0006-1624-0641"
    },
    {
      "affs": [
        0
      ],
      "name": "Yishan Chen",
      "orcid": "0009-0001-5474-5900"
    },
    {
      "affs": [
        1
      ],
      "name": "Mohammed Ruzieh",
      "orcid": "0000-0002-7796-8701"
    },
    {
      "affs": [
        0
      ],
      "name": "Carl J. Pepine",
      "orcid": "0000-0002-6011-681X"
    },
    {
      "affs": [
        0
      ],
      "name": "Steven Smith",
      "orcid": "0000-0002-0201-839X"
    },
    {
      "affs": [
        0
      ],
      "name": "Tianze Jiao",
      "orcid": "0000-0002-2608-616X"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/4tcrhwq1zw4yv.bib",
  "cited_by": 0,
  "doi": "10.1161/jaha.125.049525",
  "fulltext_url": null,
  "id": "4tcrhwq1zw4yv",
  "issns": [
    "2047-9980"
  ],
  "landing_url": "https://www.ahajournals.org/doi/10.1161/JAHA.125.049525",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2705|Blood Pressure and Hypertension Studies"
    ]
  ],
  "openalex": "W7221321003",
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-20",
  "publisher": "Ovid Technologies (Wolters Kluwer Health)",
  "ris": "https://research.draconitic.com/paper/4tcrhwq1zw4yv.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:28Z",
      "native_id": "10.1161/jaha.125.049525",
      "source": "crossref",
      "url": "https://www.ahajournals.org/doi/10.1161/JAHA.125.049525"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Blood Pressure and Hypertension Studies",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Guideline‐Directed Treatment Eligibility and Burden of Untreated Stage‐1 Hypertension Under the 2025 American College of Cardiology/American Heart Association Hypertension Guideline: Insights From NHANES 2015 to 2020",
  "title_text": "Guideline‐Directed Treatment Eligibility and Burden of Untreated Stage‐1 Hypertension Under the 2025 American College of Cardiology/American Heart Association Hypertension Guideline: Insights From NHANES 2015 to 2020",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:28Z",
  "url": "https://research.draconitic.com/paper/4tcrhwq1zw4yv",
  "venue": "Journal of the American Heart Association",
  "versions": []
}