AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Population-Level Implications of PREVENT-Guided Antihypertensive Treatment Eligibility Under the 2025 AHA/ACC Hypertension Guideline: NHANES 2017-2023
By Tewari J, Shah A, Singh V et al.
Introduction: The 2025 American Heart Association/American College of Cardiology hypertension guideline incorporates PREVENT-based cardiovascular risk assessment for treatment decisions. Its population-level implications compared with the 2017 Pooled Cohort Equations (PCE)-based framework are uncertain. Hypothesis: We evaluated whether PREVENT-guided risk assessment changes antihypertensive pharmacotherapy eligibility and untreated eligibility among United States adults. Methods: We analyzed nonpregnant NHANES 2017-March 2020 and 2021-2023 adults aged >=30 years with measured blood pressure. Survey weights generated national estimates. Under the 2017 framework, medication eligibility was defined as current antihypertensive use, blood pressure >=140/90 mm Hg, or stage 1 hypertension with diabetes, chronic kidney disease, clinical cardiovascular disease, or PCE 10-year ASCVD risk >=10%. Under the 2025 high-risk framework, PREVENT 10-year total cardiovascular disease risk >=7.5% replaced PCE-based risk. Lower-risk stage 1 hypertension was separately classified as potential medication eligibility after lifestyle therapy if blood pressure remains >=130/80 mm Hg. Results: The cohort included 11,682 adults, representing 187.2 million United States adults. Blood pressure was normal in 41.7%, elevated in 14.9%, stage 1 hypertension in 31.4%, and stage 2 hypertension in 12.1%. Pharmacotherapy eligibility was similar under the 2017 and 2025 high-risk frameworks: 45.2% versus 45.2% (84.5 versus 84.6 million adults). Newly eligible adults under the 2025 high-risk framework represented 0.2% (0.42 million), and 0.2% were no longer eligible. Untreated eligibility remained substantial: 14.9% under both frameworks, representing approximately 27.4 million adults. An additional 11.5% (21.5 million) had lower-risk stage 1 hypertension requiring lifestyle therapy and follow-up. Conclusion: PREVENT-guided high-risk pharmacotherapy eligibility was nearly unchanged compared with the 2017 PCE-based framework. The major implementation opportunity is treatment and follow-up among adults already eligible or potentially eligible after lifestyle therapy.