New Hypertension Guidelines Spare Some Older Adults from Immediate Treatment

Analysis shows 2025 guidelines reduce immediate drug therapy for a small subset of adults aged 65-79 with stage I hypertension.

Mar. 18, 2026 at 8:33am

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A new analysis found that updated hypertension guidance from 2025 modestly reduces the number of older adults recommended for immediate drug therapy. The study examined data from over 3,000 adults aged 65-79 with untreated stage I hypertension and found that 11.4% would no longer meet criteria for immediate treatment under the new guidelines, which focus more on individualized risk assessment using the PREVENT score.

Why it matters

The updated guidelines place a stronger emphasis on lifestyle changes and a trial period before medication for lower-risk older adults with stage I hypertension. This reflects a shift away from an age-based approach and aims to avoid unnecessary medication use in this population.

The details

The analysis looked at National Health and Nutrition Examination Survey data from 2013-2020 and found that the patients reclassified as ineligible for immediate treatment tended to be female, nonsmokers aged 65-68 with relatively healthy cholesterol, kidney function, and blood pressure levels. Their PREVENT scores, which estimate 10-year cardiovascular disease risk, were between 4.8% and 7.4%.

  • The data was drawn between 2013 and 2020.
  • The new 2025 hypertension guidelines were analyzed in this study.

The players

Sridhar Mangalesh, MD

Resident physician at Jacobi Medical Center in Bronx, New York, and a first author of the study.

Michael Nanna, MD

Assistant professor of internal medicine at Yale School of Medicine in New Haven, Connecticut, and an author of the study.

Laura Mayeda, MD, MPH

Clinical assistant professor in the Department of Medicine at the University of Washington School of Medicine in Seattle.

PREVENT

A risk assessment tool that captures a person's 10-year risk of developing major cardiovascular disease by combining factors like age, sex, blood pressure, cholesterol, kidney function, diabetes, smoking, and medication use.

American Heart Association and the American College of Cardiology

The organizations that released the updated 2025 hypertension guidelines.

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What they’re saying

“In the past, many adults age 65 and older with stage I hypertension would often have been considered candidates for medication based mainly on age.”

— Sridhar Mangalesh, MD, Resident physician

“The 2025 guideline places strong emphasis on lifestyle changes across a wide range of patients, and in lower-risk people with stage I hypertension, it explicitly supports a 3- to 6-month trial of lifestyle intervention before medication.”

— Michael Nanna, MD, Assistant professor of internal medicine

“Unlike ASCVD, PREVENT explicitly integrates kidney and metabolic function into risk prediction.”

— Laura Mayeda, MD, MPH, Clinical assistant professor

What’s next

The new guidelines are not expected to significantly upend clinical practice, as most older adults with stage I hypertension will still qualify for immediate medication under the updated framework.

The takeaway

The 2025 hypertension guidelines represent a shift towards more personalized, risk-based treatment, sparing a small subset of lower-risk older adults from immediate drug therapy in favor of a trial of lifestyle interventions first.