New US blood-pressure thresholds would label 92% of Lagos adults hypertensive
Applying the 2025 AHA/ACC guideline to a Nigerian survey sharply raised the share classified hypertensive versus older criteria, widening the gap between diagnosis and treatment capacity.
| Group | Value (%) |
|---|---|
| AHA/ACC 2025 | 92 |
| JNC 7 | 44.2 |
Where you draw the line for "high blood pressure" decides how many people have it. When the American Heart Association and American College of Cardiology tightened their definition, the change rippled well beyond the United States, because guidelines from major bodies are widely adopted elsewhere. A cross-sectional study published on 1 September in BMJ Public Health asks what the 2025 AHA/ACC guideline would mean if applied in Lagos, Nigeria — and finds the numbers balloon [s1].
What the study did
The authors reanalysed data from a population-based hypertension survey in Lagos, classifying each participant three ways: by the 2025 AHA/ACC guideline, by the older Seventh Report of the Joint National Committee (JNC 7), and as known hypertensives already on treatment [s1]. They then compared prevalence, eligibility for drug treatment, cardiovascular-risk profile and blood-pressure control across those groupings [s1]. Two components of the AHA/ACC eligibility rules — those based on kidney disease and on a formal cardiovascular-risk calculator — were excluded, a limitation the authors note [s1].
What it found
Among 3,030 participants aged 17 to 92, the 2025 AHA/ACC criteria classified 2,788 people — 92.0% — as hypertensive, against 1,340 (44.2%) under JNC 7 [s1]. Only 242 participants (8.0%) were known, treated hypertensives [s1]. The newer guideline identified a higher proportion of hypertensives among adults aged 20 to 39, pulling younger people into the category [s1].
Eligibility for medication rose accordingly. Compared with JNC 7, the AHA/ACC 2025 guideline increased pharmacotherapy eligibility by 17.2% in men and 18.0% in women, with the largest increments — 23.6% and 25.5% — among adults under 20 and 60 or older, respectively [s1]. Over a third of participants qualified for lifestyle modification alone under both guidelines [s1].
The control figures are the sting in the tail. Among treated hypertensives, the share meeting the blood-pressure target was 19.4% under JNC 7 but only 10.7% under the stricter AHA/ACC 2025 target [s1]. Tightening the definition does not just create more patients; it also reclassifies more of the already-treated as inadequately controlled.
How to read it
This is a modelling exercise on survey data from one city, not a study of what happens when a country adopts a guideline. It cannot say whether treating this larger group would actually prevent strokes and heart attacks — that benefit is the rationale for lower thresholds, and it may well be real, but it is assumed here rather than measured [s1]. The excluded kidney-disease and risk-calculator criteria mean the true eligibility shift could differ. And a single urban survey does not represent all of Nigeria, let alone other low- and middle-income settings.
What the study does show cleanly is the arithmetic of a threshold change in a place where treatment capacity is already stretched. Reclassifying 92% of surveyed adults as hypertensive, in a setting where only 8% are on treatment, defines a gap between diagnosis and care that no stroke of the pen closes [s1].
Why it matters
The authors' conclusion is pointed: earlier identification of hypertension may bring long-term cardiovascular benefit, but realising it in a low-resource setting depends on medicine supply, workforce capacity and the feasibility of laboratory-based eligibility rules — none of which scale automatically with a broader definition [s1]. Guidelines written for one health system carry implicit assumptions about that system's resources. This paper is a reminder that importing the threshold without the infrastructure mostly imports the label.
This article is informational and does not constitute medical advice.
Sources
- [s1] Implications of the 2025 AHA/ACC hypertension guideline on hypertension prevalence, treatment eligibility and blood pressure control in Nigeria: a cross-sectional comparative study. BMJ Public Health, 1 September 2026. https://doi.org/10.1136/bmjph-2026-005006
Sources
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