A new study published in the American Heart Association journal Hypertension suggests that long-term risk should be considered when deciding when to start blood pressure-lowering medication in people with stage 1 hypertension.
Researchers found that many people may have a low short-term risk of heart problems but still face a high lifetime risk of serious conditions like heart attack, stroke, or heart failure.
The study, led by Dr. Paul Muntner from the University of Alabama at Birmingham, compared two risk prediction tools: the American Heart Association’s new PREVENT calculator and the older Pooled Cohort Equations (PCE).
The PREVENT calculator, introduced in 2023, can estimate both 10-year and 30-year risks of heart attack, stroke, and heart failure. It also takes into account kidney health, blood sugar control, and social factors. In contrast, the PCE estimates only 10-year risk and does not include heart failure or newer risk markers.
Researchers used data from 1,703 adults aged 30 to 79 years old with stage 1 high blood pressure (130–139/80–89 mm Hg) from the U.S. National Health and Nutrition Examination Survey (NHANES). None of the participants had a previous history of heart disease or stroke.
They found that using the PREVENT calculator, the average 10-year risk of heart attack and stroke was 2.9%, while the PCE showed a higher risk of 5.4%. This means that fewer people would be flagged for treatment using PREVENT’s 10-year risk threshold compared to the PCE.
However, 55% of people who had a high 10-year risk by PCE still had a 30-year risk of 30% or more when calculated with PREVENT—indicating they might benefit from medication over the long term.
Dr. Muntner emphasized that, “People may want to talk with their doctors about starting medication even if their short-term risk is low. Long-term risk matters, too.”
Participants in the study had an average age of 49.6 years. Around 55% were men and 45% were women. Most were white (66%), while 15.5% were Hispanic, 10% were Black, and 6% identified as Asian or another ethnicity. About 17% smoked, 9.6% were on statins, and some had diabetes or chronic kidney disease.
The study also highlighted racial disparities in cardiovascular health. For example, Black adults in the U.S. are more likely to experience stroke or heart failure than white adults. Dr. Muntner said it’s essential to ensure equal access to effective treatments, as all groups benefit from blood pressure-lowering therapy.
However, there were limitations. Blood pressure was only measured once during a single visit, not across multiple visits as recommended by clinical guidelines. The study was also based on cross-sectional data, meaning it only looked at one point in time and didn’t track actual health outcomes.
Still, experts believe the findings are important. Dr. Sadiya S. Khan from Northwestern University, who was not involved in the study, said it highlights the value of estimating both short- and long-term risk. “Estimating risk is the first step to starting conversations between patients and clinicians,” she said.
She added that the study supports the importance of future clinical trials, especially for younger people with high long-term risk and groups such as women with a history of high blood pressure during pregnancy. These insights could help refine when to begin medications and how best to protect heart health over a lifetime.
If you care about blood pressure, please read studies that widely used blood pressure drug may increase eye disease risk and common blood pressure drugs linked to cognitive decline.
For more information about blood pressure, please read studies about why checking blood pressure while lying down is very important and lowering top blood pressure number to less than 120 mm Hg effectively prevents heart disease.
The study is published in Hypertension.
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