Oluseyi Adegoke, Okechukwu S Ogah, Njideka U Okubadejo
Application of the 2025 AHA/ACC guideline increased the burden of hypertension and pharmacotherapy eligibility in Nigeria, widening the gap between eligibility and current treatment and control rates. While this reflects earlier identification of hypertension with potential long-term cardiovascular benefit, realising this advantage in low-resource settings will require considering its implications for medicine supply, workforce capacity, and the feasibility of laboratory-based eligibility criteria in this setting.
INTRODUCTION: The blood pressure (BP) threshold at which pharmacotherapy benefit outweighs the risk of withholding treatment remains dynamic with advancing knowledge. This study explored the implications of the 2025 American Heart Association/American College of Cardiology (AHA/ACC) guideline on hypertension prevalence, treatment eligibility and BP control in Nigeria.
METHODS: This was a secondary analysis of a population-based cross-sectional hypertension survey in Lagos, Nigeria. Participants were categorised as AHA/ACC 2025, Seventh Report of the Joint National Committee (JNC 7) or known hypertensives on treatment. Demographic characteristics, hypertension staging, pharmacotherapy eligibility, cardiovascular risk profile and target BP control rates were compared across categories (kidney disease-eligibility and Predicting Risk of Cardiovascular Disease Events tool-based eligibility were excluded).
RESULTS: Among 3030 participants aged 17-92 years, 2788 (92.0%) met AHA/ACC 2025 criteria, 1340 (44.2%) met JNC 7 criteria and 242 (8.0%) were known treated hypertensives. AHA/ACC 2025 identified a higher proportion of hypertensives aged 20-39 years. Over half of participants in both AHA/ACC 2025 and JNC 7 categories had stage 1 hypertension. Compared with JNC 7, AHA/ACC 2025 increased pharmacotherapy eligibility by 17.2% in males and 18.0% in females, with the largest increments (23.6% and 25.5%) in adults aged <20 and ≥60 years, respectively. Over a third required lifestyle modification alone under both guidelines. Among treated hypertensives, target BP control rate was 19.4% (JNC 7) and 10.7% (AHA/ACC 2025).
CONCLUSIONS: Application of the 2025 AHA/ACC guideline increased the burden of hypertension and pharmacotherapy eligibility in Nigeria, widening the gap between eligibility and current treatment and control rates. While this reflects earlier identification of hypertension with potential long-term cardiovascular benefit, realising this advantage in low-resource settings will require considering its implications for medicine supply, workforce capacity, and the feasibility of laboratory-based eligibility criteria in this setting.