For years, turning 65 with a blood pressure reading above 130 meant one thing: medication.

A new analysis of the 2025 American Heart Association guidelines shows that this practice is changing, finding that roughly 10 percent of older adults previously flagged for treatment may no longer meet the criteria, a move experts say prevents overtreatment, but one that carries its own risks.

The 2025 guidelines marked a significant departure from the 2017 AHA guidelines, which recommended treatment for all adults over 65 with blood pressure at or above 130/80 mmHg.

The updated 2025 guidelines replace that blanket approach with one that weighs a patient’s 10-year cardiovascular disease (CVD) risk, offering what experts describe as a more personalized lens on heart health.

Under the new framework, immediate medication is no longer recommended based only on age and blood pressure levels, but also with consideration of the individual’s other cardiovascular risk factors. This translates to around 1 in 10 Americans over the age of 65 with early hypertension who would no longer being recommended medication.

More than 70 million Americans are currently taking medication to lower their blood pressure and reduce their risk of heart attack and stroke. However, these drugs can sometimes cause side effects like dizziness, fatigue, and kidney problems, making the question of who truly needs treatment a consequential one.

Personalized Treatment for Older Adults

The report, recently published in Annals of Internal Medicine, offers evidence that a risk-guided approach may be the right direction.

Researchers analyzed data from 2,200 adults aged 65 to 79 with high blood pressure. They compared two groups: one that received treatment based on the 2017 guidelines, and another based on the current ones, which are guided by each person’s overall health risk profile.

They found that around 1 in 10 Americans over the age of 65 with Stage 1 hypertension would no longer be recommended medication, provided that they are otherwise healthy with no other cardiovascular risk factors.

Stage 1 hypertension is defined by blood pressure readings of 130 to 139 mmHg systolic or 80 to 89 mmHg diastolic.

The study also found that about 40 percent of older adults with high blood pressure could benefit from treatment that considers their overall health risks, not just their blood pressure numbers. This risk-guided approach could prevent overmedication of patients and thereby shield more patients from the potential side effects of blood pressure medication, while still reducing cardiovascular disease risk.

“The art now is to match the intensity of treatment to both global cardiovascular risk and the patient’s blood pressure, rather than chasing a number at all costs and treating all older patients with a ‘one size fits all’ approach,” Dr. Carolyn Lam, senior consultant cardiologist at the National Heart Center of Singapore and co-founder of AI medtech platform Us2.ai, told The Epoch Times.

In older adults, the concerns with over-aggressive blood pressure lowering include dizziness, falls, fractures, and acute kidney injury, especially in those who are frail or have chronic kidney disease, Lam noted.

The risk-guided approach, she explained, concentrates intensive treatment where the absolute benefit is greatest—typically in patients with diabetes, kidney disease, or multiple cardiometabolic risks—while avoiding unnecessary polypharmacy in lower-risk patients.

“Done well, this can reduce heart attacks, strokes, and heart failure, yet also help preserve independence and quality of life in later years,” Lam said.

Overtreatment vs. Undertreatment

Dr. Peter Kowey, William Wikoff Smith Chair in Cardiovascular Research and professor of Medicine and Clinical Pharmacology at Thomas Jefferson University in Philadelphia, told The Epoch Times that the obvious concern is that we don’t want to over-medicate people, especially over the age of 65.

“Many of these people are fragile,” he pointed out, and have blood pressure that goes up and down in a way that can be difficult to predict.

“Some of them have periods where their blood pressures go very low on their own, and then the blood pressure medication is quite difficult to use because you’re trying to abolish the high values, but you don’t want them to be exposed to low [blood pressure] values,” he said.

However, Kowey also warned that the report may have the unintended consequence of reducing treatment for those who really need it.

“I have a big problem with this,” he said. “It’s very analogous to what we’ve done with statins and LDL.”

He compared the new model for prescribing antihypertensive drugs to the risk models applied from previous guidelines on statin prescription statins and LDLs, which reduced the number of Americans that would once be candidates for statin medication by up to 40 percent.

Because the new risk model requires considering all relevant risk factors for treating high blood pressure, Kowey said a primary care doctor who is not savvy enough or doesn’t have enough time to do all the risk assessments is likely to get the wrong message.

“Which is, ‘well, I don’t have to treat this guy or this lady,’ and I think that could be a big trap,” he warned.

Kowey emphasized that he would very much not want primary care doctors to be, in the 10 minutes that they have spent with a patient, “sitting there wringing their hands about whether they should treat a blood pressure of 160 over 100 because of the risk factor issue.”

He concluded that the big challenge isn’t getting people off medications—“The big challenge here is finding all the people out there that need to be treated and giving them something that works, and that they can tolerate.”