Deciding whether to take medication for high blood pressure has been a complex issue.
Traditionally, doctors have used a tool that calculates someone’s 10-year risk of having a heart attack or stroke. But new research suggests that this short-term focus might miss a bigger picture—one that looks at risks over 30 years.
A recent study, published in the journal Hypertension, introduced new equations that take into account both 10-year and 30-year risks for cardiovascular disease.
According to Dr. Paul Muntner, the study’s lead author and a visiting professor at the University of Alabama at Birmingham, many people might have a low risk of heart attack or stroke in the next 10 years but a much higher risk over the next 30 years.
This finding suggests that understanding both short-term and long-term risks could be crucial in deciding whether to start medication.
High blood pressure, or hypertension, is a common condition affecting nearly half of U.S. adults. It occurs when the force of blood flowing through the arteries is too strong, which can damage blood vessels and lead to serious health problems like heart attack, stroke, and kidney disease.
Hypertension is classified into two stages. Stage 1 is when the systolic (top) blood pressure number is between 130-139 mmHg, or the diastolic (bottom) number is between 80-89 mmHg.
Stage 2 is when the systolic number is 140 mmHg or higher, or the diastolic number is 90 mmHg or higher. For stage 2, medication is generally recommended, but for stage 1, the decision depends on a person’s overall cardiovascular risk.
The American Heart Association (AHA) and American College of Cardiology introduced new blood pressure guidelines in 2017, considering the risk of atherosclerotic cardiovascular disease—a condition involving plaque buildup in the arteries.
This risk was measured using the Pooled Cohort Equations (PCEs), which estimate a person’s 10-year risk of heart attack or stroke based on factors like age, cholesterol levels, and whether they have diabetes.
However, these calculations have limitations. For example, they don’t account for the risk of heart failure, and they don’t consider the widespread use of statins (cholesterol-lowering drugs). To address these gaps, the AHA published a new set of equations in 2023 called PREVENT.
This tool predicts both the 10-year and 30-year risks for cardiovascular events and includes additional factors like kidney function, blood sugar levels, and social determinants of health, such as income and education.
The study found that among adults with stage 1 hypertension, the PREVENT tool often showed a lower 10-year risk but a higher 30-year risk compared to the PCE tool. This suggests that even if short-term risk is low, long-term risk may still be high, and medication might be beneficial.
Dr. Muntner emphasized the importance of discussing both short-term and long-term risks with healthcare providers.
While lifestyle changes—like reducing salt intake, exercising, and losing weight—are the first steps to managing blood pressure, medication may be necessary if these changes aren’t enough. Knowing the 30-year risk might motivate people to take action early, preventing serious health problems down the road.
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