For a long time, the decision of whether to use medication to reduce high blood pressure had been guided by a tool that calculated an individual’s 10-year risk of experiencing a heart attack or stroke. However, a recent study published in the journal Hypertension introduces new equations that consider both the 10-year and 30-year predicted risk for cardiovascular disease. This study suggests that even if the short-term risk is low, the long-term risk remains high for some individuals.
Dr. Paul Muntner, the lead author of the study and a visiting professor at the University of Alabama at Birmingham, highlights that many people might have a low risk of heart attack and stroke within 10 years but face a high risk over the next 30 years. Therefore, understanding the risk for both 10 and 30 years is advised when deciding whether to initiate medication.
Around half of adults in the United States have high blood pressure, also known as hypertension, which can lead to various health issues like heart attack, stroke, heart failure, and kidney disease. The stages of hypertension are determined based on the systolic and diastolic blood pressure readings.
The 2017 American Heart Association and American College of Cardiology blood pressure guidelines recommend lifestyle modifications and medication for individuals with stage 2 hypertension. The decision to start medication for stage 1 hypertension also considers the level of blood pressure and the risk of atherosclerotic cardiovascular disease.
However, the methods for determining cardiovascular disease risk have evolved. The new AHA publication in 2023 introduces a set of cardiovascular risk prediction equations called PREVENT. This new calculator predicts the risk of heart failure in addition to plaque-related cardiovascular disease over the next 10 years for individuals aged 30 to 79, and over the next 30 years for those aged 30 to 59.
PREVENT considers additional factors such as kidney function, blood sugar levels, cholesterol-lowering medication use, and social determinants of health. It does not include race as a variable, recognizing race as a social construct rather than a biological factor.
The study compared cardiovascular disease risks using the PCE tool and the PREVENT calculator in adults with hypertension. While the PCE tool showed a higher average 10-year risk of heart attack or stroke compared to PREVENT, the 30-year risk calculations presented different outcomes.
The findings suggest that for individuals under 60 with stage 1 hypertension and a high 10-year risk as per the PCE tool, they might face a high 30-year risk of heart-related issues using PREVENT, even if the 10-year risk appears low.
Dr. Muntner emphasizes the importance of considering both short-term and long-term risks and involving patients in the decision-making process regarding hypertension treatment. Lifestyle changes such as reducing salt intake, exercise, weight loss, and stress reduction are crucial in managing blood pressure before considering medication.
Understanding the long-term risk of cardiovascular disease may motivate individuals to adopt healthier habits or use blood pressure-lowering medication when necessary, preventing potential health complications related to hypertension.