Qi, J., Yishan, C., Mohammed, R., J, P.C., Steven, S., & Tianze, J. (2026). 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.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.125.049525
Qi J, Yishan C, Mohammed R, J PC, Steven S, Tianze J. 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.. Journal of the American Heart Association. 2026; doi: 10.1161/JAHA.125.049525
Qi J, Yishan C, Mohammed R, et al. 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.[J]. Journal of the American Heart Association. 2026. DOI: 10.1161/JAHA.125.049525.
@article{qi2026,
author = {Jian Qi and Chen Yishan and Ruzieh Mohammed and Pepine Carl J and Smith Steven and Jiao Tianze},
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.},
journal = {Journal of the American Heart Association},
year = {2026},
doi = {10.1161/JAHA.125.049525},
note = {PMID: 42858041},
}
TY - JOUR AU - Jian Qi AU - Chen Yishan AU - Ruzieh Mohammed AU - Pepine Carl J AU - Smith Steven AU - Jiao Tianze 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. T2 - Journal of the American Heart Association PY - 2026 DO - 10.1161/JAHA.125.049525 AN - PMID:42858041 ER -
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.