Nearly 80% of US adults with hypertension exceeded recommended blood pressure thresholds, including many who were already receiving antihypertensive therapy, according to a research letter in JAMA.

Using National Health and Nutrition Examination Survey data from 2021 to 2023, researchers found that adults receiving antihypertensive medication were more likely than untreated adults to have blood pressure levels at least 10, 20, or 30 mmHg above guideline targets.

Among adults with uncontrolled blood pressure (BP), an estimated 61% were not taking antihypertensive medication, while 39% reported current medication use. Adults not receiving antihypertensive therapy were younger on average (mean age 49 vs 62 years) and less likely to have health insurance (89% vs 95%) or a routine place for health care (83% vs 96%) compared with those taking medication.

Those not taking medication were also less likely to meet the study definition for high cardiovascular disease (CVD) risk (34% vs 72%). This difference likely reflects clinical practice patterns: patients with established CVD, diabetes, or chronic kidney disease are more likely to have already been prescribed antihypertensive therapy. Despite these differences, nearly two-thirds of untreated adults with uncontrolled BP had systolic and diastolic values within 10 mmHg of the recommended goal; the researchers noted "many could potentially achieve BP control with initiation of antihypertensive medication and lifestyle modification."

In contrast, adults with uncontrolled BP who were already taking antihypertensive medication had more pronounced elevations above target. An estimated 53% had systolic or diastolic BP at least 10 mmHg above goal, 25% were at least 20 mmHg above goal, and 11% were at least 30 mmHg above goal. This population was older and had a higher prevalence of diabetes, chronic kidney disease, and established CVD, with more than 70% meeting the study definition for high CVD risk. For these patients, treatment intensification, including use of combination therapy, may be necessary to achieve guideline-recommended BP targets.

Several limitations should be considered. The analysis applied BP targets from the 2025 American Heart Association (AHA) and American College of Cardiology (ACC) guideline to data collected between 2021 and 2023; however, the less than 130/80 mmHg goal was consistent with prior guideline recommendations for most adults receiving antihypertensive therapy. Antihypertensive medication use in the survey was self-reported, which may introduce misclassification.

Disclosures can be found in the research letter.

Source: JAMA