An estimated nearly four out of five U.S. adults with hypertension have blood pressure (BP) above the 2025 AHA/ACC guideline goal of <130/80 mm Hg, according to 2021-2023 data from the National Health and Nutrition Examination Survey (NHANES) published Feb. 2 in JAMA.

Hypertension was identified in JACC's 2026 Cardiovascular Statistics in the United States report as one of the major risk factors for cardiovascular deaths and disability in the U.S., with related deaths nearly doubling within the past two decades while treatment rates have stagnated.

The current study results found that 79% of 3,216 individuals aged ≥20 with hypertension had a systolic BP level ≥130 mm Hg, diastolic BP ≥80 mm Hg or self-reported use of antihypertensive medication. Additionally, 61% were not taking antihypertensive medication. They tended to be younger (49 vs. 62 years), less likely to have health insurance (89% vs. 95%) and a place for routine health care (83% vs. 96%) and higher risk cardiovascular disease (estimated 34% vs. 72%) compared with those taking antihypertensives.

Notably, BP levels significantly higher than systolic or diastolic goals were more likely in those taking vs. not taking medication. Specifically, 53% vs. 35% for ≥10 mm Hg above goal, 25% vs. 13% for ≥20 mm Hg above and 11% vs. 6%, respectively. These individuals also had a higher prevalence of diabetes or chronic kidney disease and they were more likely to have a history of cardiovascular disease, high risk cardiovascular disease or a 10-year cardiovascular ≥7.5%.

Of those not taking antihypertensive medications, 65.4% were likely to be within 10 mm Hg of BP goals, the authors note, "indicating that many could potentially achieve BP control with initiation of antihypertensive medication and lifestyle modification."

Another gap in care is the "more than 80% of adults with uncontrolled BP" who had health insurance and place for routine health care, write the authors. They highlight that implementing recommendations from the 2025 ACC/AHA BP guideline, earlier and more intensively, could address this gap in BP care.