New research suggests that when deciding whether to start medication for high blood pressure, it’s important to consider not just the short-term, but also the long-term risk of developing cardiovascular disease (CVD).
This study, published in Hypertension, compares two tools used to calculate these risks: the American Heart Association’s PREVENT calculator and the Pooled Cohort Equations (PCE).
“Many people may not have a heart attack or stroke, or develop heart failure in the next few years, yet they may benefit from lowering their blood pressure to protect them against these conditions later in life,” said Paul Muntner, Ph.D., the study’s lead author and a visiting professor at the University of Alabama at Birmingham.
He suggests that experts should consider both near-term and lifetime risks for heart disease when making treatment recommendations.
The study compared the predicted risks using PREVENT, released in 2023, and the older PCE tool. PREVENT stands for Predicting Risk of Cardiovascular Events and uses sex-specific equations.
It includes markers of kidney disease and blood sugar levels, and it estimates both 10-year and 30-year risks for heart attack, stroke, and heart failure. It also considers additional risk factors, such as social and economic conditions.
In contrast, the PCE tool only calculates a 10-year risk and does not include heart failure or other risk factors like kidney function or statin use.
It was designed to assess the 10-year risk of heart attack and stroke for individuals aged 40 to 79, while PREVENT can assess CVD risk in individuals aged 30 to 79 and predict both 10-year and 30-year risks.
According to the 2017 ACC/AHA Guideline for managing high blood pressure in adults, a 10-year risk of heart attack or stroke of 10% or greater, as estimated by the PCEs, is considered high risk and should prompt discussions about blood pressure-lowering medications.
For this study, a 10-year risk of 15% or higher, estimated by PREVENT, was considered high risk.
Researchers analyzed data from the U.S. National Health and Nutrition Examination Survey (NHANES) from 2013 to 2020, including 1,703 adults aged 30 to 79 with stage 1 hypertension.
They compared the participants’ predicted risks of CVD using both tools and found some notable differences.
The average 10-year risk for heart attack and stroke was 2.9% using PREVENT, compared to 5.4% using the PCE tool. This means that if the same risk thresholds were used, some people might not be advised to start medication based on the PREVENT prediction.
However, the study found that many of these people had a high 30-year risk, which could be crucial information for deciding on treatment.
“Many people with stage 1 high blood pressure who are not likely to have a heart attack, stroke, or heart failure within the next 10 years may have a high risk over the next 30 years,” Muntner explained.
“People may want to discuss this with their doctors and consider starting antihypertensive medication to lower their blood pressure to reduce their long-term risk.”
The study participants had an average age of 49.6 years, with 55% identifying as men and 45% as women. The group was diverse, with 65.8% identifying as white, 15.5% as Hispanic, 10.1% as Black, 5.8% as Asian, and 2.7% as other races or ethnicities.
Additionally, 17.2% of participants smoked, 9.6% were taking statin medications, 8.4% had diabetes, and 9.1% had chronic kidney disease.
Blood pressure was measured during a single visit, and participants answered questions about their health and medical history. Those with a prior diagnosis of coronary disease, heart attack, stroke, or heart failure were excluded from the analysis.
“Cardiovascular prevention is important for people of all races and ethnic groups. Non-Hispanic Black adults have a higher risk of stroke and heart failure compared with other groups,” Muntner noted. “Ensuring equal access to treatments that lower blood pressure is crucial for all adults.”
The study had some limitations, such as using blood pressure measurements from a single visit and combining data from multiple years to ensure a large enough sample size.
Despite these limitations, the findings highlight the importance of considering both short- and long-term risks when treating high blood pressure.
Sadiya S. Khan, M.D., who was not involved in the study, emphasized the significance of the findings.
“This study highlights that the burden of stage 1 hypertension is high, and our goals should be to keep blood pressure as optimal as possible for as long as possible,” she said. “This can be achieved through lifestyle changes and, when necessary, medication.”
The results underscore the value of using accurate and precise risk models to guide treatment decisions and improve health outcomes for individuals with high blood pressure.
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The research findings can be found in Hypertension.
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