Objective:

To evaluate the potential impact of the 2025 hypertension guidelines on mortality among US adults with hypertension.

Approach:

• Study Design: A retrospective cohort study using National Health and Nutrition Examination Survey data from 2009 to 2018 and linked mortality records through 2019.
• Population: About 81 million US adults aged 30 to 79 years with hypertension without established cardiovascular disease.
• Eligibility Criteria: Patients with blood pressure of at least 130/80 mmHg and either diabetes, chronic kidney disease, or a 10-year cardiovascular disease risk of at least 7.5%.
• Outcomes: Primary outcome was all-cause mortality; secondary outcome was cardiovascular mortality.
• Analysis: Adjusted survival models and simulation analyses to estimate population-level effects of guideline implementation.

Key Findings:

• Among nearly 23 million eligible adults, 43% remained untreated, indicating a significant treatment gap.
• Antihypertensive therapy was associated with a 23% lower likelihood of all-cause mortality and a 50% lower likelihood of cardiovascular mortality.
• At 10 years, treatment was linked to a 2.1% reduction in all-cause mortality and a 1.7% reduction in cardiovascular mortality.
• Treating all eligible but untreated patients could prevent nearly 201,000 all-cause and 163,000 cardiovascular deaths over the next decade.
• The greatest benefits were observed in patients with diabetes.

Interpretation:

Limitations:

• Non-randomized treatment assignment may lead to residual confounding.
• Projected mortality reductions are based on observational data and simulation models, not causal inference.
• Findings may not be generalizable to all patient populations.

Conclusion:

Sources:

• Journal of the American Heart Association