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
- 1University of Florida
- 2Northwestern University Feinberg School of Medicine
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.
Related
- Dyslipidemia management in athletes: A comparative commentary on the 2026 ACC/AHA/Multisociety Guideline and contemporary sports cardiology recommendations.
- Renal denervation beyond resistant hypertension: should drug intolerance redefine eligibility?
- Effects of Psycho-Cardiology Model-Based Psychological and Behavioural Management on Negative Emotions and Sleep Disorders in Patients With Resistant Hypertension Complicated by Anxiety and Depression
- Treatment Adherence and its Association with Demographic Characteristics and Clinical Factors Among Patients with Hypertension: A Cross-Sectional, Descriptive-Correlational Study.
- Association Between Depressive Symptom Severity and Treatment Adherence Among Primary Care Patients with Hypertension in Taizhou, East China: A Multicenter Cross-Sectional Study
BibTeX
@article{jian2026guidelinedirected,
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}},
author = {Qi Jian and Yishan Chen and Mohammed Ruzieh and Carl J. Pepine and Steven Smith and Tianze Jiao},
journal = {Journal of the American Heart Association},
year = {2026},
month = oct,
doi = {10.1161/jaha.125.049525},
url = {https://www.ahajournals.org/doi/10.1161/JAHA.125.049525},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - 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
AU - Qi Jian
AU - Yishan Chen
AU - Mohammed Ruzieh
AU - Carl J. Pepine
AU - Steven Smith
AU - Tianze Jiao
PY - 2026
DA - 2026/10/20
JO - Journal of the American Heart Association
DO - 10.1161/jaha.125.049525
UR - https://www.ahajournals.org/doi/10.1161/JAHA.125.049525
AB - 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.
SN - 2047-9980
ER -