Assessing Long-Term Risk of CVD May Help Inform When to Start Hypertension Treatment

A comparison of 2 risk prediction tools used to calculate the risk of cardiovascular disease (CVD) indicates that long-term, 30-year risk should be considered along with short-term, 10-year risk when assessing when to begin medication for stage 1 hypertension. The results were published this week in Hypertension. 

“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 having a heart attack, stroke, or heart failure later in life,” said Paul Muntner, PhD, MHS, FAHA, lead study author and a visiting professor in the Department of Epidemiology at the University of Alabama at Birmingham, via a press release. “Experts who develop [CVD] guidelines may want to consider both near-term risk and lifetime risk for having heart disease, stroke, and heart failure in lifestyle changes and treatment recommendations.”

To conduct this study, researchers compared the predicted risks estimated by the American Heart Association’s PREVENT risk calculator with Pooled Cohort Equations (PCEs). Researchers noted PREVENT utilizes sex-specific equations, incorporates markers of kidney disease in addition to HbA1c measures to help monitor metabolic health, estimates 10-year and 30-year risk of heart attack or stroke as well as heart failure, and considers additional risk factors with the social deprivation index.

The analysis comprised 1703 adults aged 30 to 79 years with stage 1 hypertension (130-139 mm Hg/80-89 mm Hg). The analysis showed that:

• The average 10-year estimated risk of heart attack and stroke was 2.9% when calculated by PREVENT compared with 5.4% with PCEs. Meaning that if treatment guidelines utilized the same threshold for PREVENT as for PCEs, some people may not be told to start blood pressure-lowering medication therapy based on the PREVENT predictions.
• However, some of these patients did have a high risk of heart attack, stroke, and heart failure over the next 30 years, which can now be estimated using the PREVENT calculator. Specifically, the analysis showed that 55.3% of adults who had a high 10-year risk with PCEs had a low 10-year risk using PREVENT; however, the 30-year risk was greater than or equal to 30.0%, which may be considered high risk. The researchers noted that this finding suggests the potential need for clinicians to consider both short- and long-term cardiovascular risks with hypertensive patients.

“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,” Dr. Muntner said. “People may want to discuss this with their doctors and consider starting antihypertensive medication to lower their blood pressure to reduce their risk for heart attack, stroke, and heart failure across their lifetime even if they have a low short-term risk.”