How do the doctors decide whether to prescribe you a medication to lower high blood pressure or not? For many years, they have partly leaned upon a 10-year CVD risk analysis. It means assessing the probability of having a heart attack or stroke in the next ten years.
The new study published this week in the journal Hypertension demonstrates the equations, which take into account both 10-year and 30-year predicted risk for cardiovascular disease. They suggest that even if short-term risk is low, the long-term risk often remains high for some people.
Dr. Paul Muntner, the study’s lead author and a visiting professor at the University of Alabama at Birmingham:
“It turns out a lot of people have a low risk for heart attack and stroke over 10 years but a high risk over the next 30 years. So, our conclusion is that it may be worthwhile for people to understand the risk for both 10 and 30 years when considering whether to start taking medication.”
The traditional way to assess CVD risk
Under the 2017 AHA guidelines, atherosclerotic cardiovascular disease risk was considered high if a person met one or more of five conditions. These included being 65 or older, having diabetes, chronic kidney disease, a history of cardiovascular disease or a 10% or greater risk of having a heart attack or stroke within 10 years, as measured by the Pooled Cohort Equations, or PCEs.
PCEs estimate a person’s 10-year risk for heart attack and stroke based on risk factors that include their age, gender, race, cholesterol levels, systolic blood pressure, and whether they take blood pressure-lowering medication, have diabetes or smoke. These equations base their conclusions on the data from the 1980s through the 2000s.
The new way to assess CVD risk
Since the early 2000s, new research and treatment advances have emerged that may affect the risk calculations.
Researchers now understand that hypertension also increases the risk for heart failure, an outcome not included in the PCEs. And the use of statins, a class of cholesterol-lowering medication, has since become widespread, partly reducing cardiovascular risks for many people.
So, in 2023, the AHA published a new set of cardiovascular risk prediction equations, known as PREVENT. The new calculator predicts the risk of heart failure in addition to the risk of plaque-related cardiovascular disease over the next 10 years in people ages 30 to 79 and over the next 30 years in people ages 30 to 59.
The new tool incorporated kidney function, blood sugar level and the use of cholesterol-lowering medication. It also accounted for social determinants of health such as income, education, employment, where a person lives, whether they have access to transportation or live in a crowded or single-parent home.
The newest way to assess CVD risk
In the new study, researchers compared 10-year cardiovascular disease risks using both types of risk equations for adults 30 to 79 with stage 1 hypertension. They also calculated the 30-year risk for adults with high blood pressure who were 30 to 59 years old.
The findings showed that among 1,703 adults with stage 1 hypertension, the average 10-year risk of having a heart attack or stroke was 5.4% using the PCE tool, compared to 2.9% using the PREVENT calculator.
However, when risks three decades out were calculated, a different story emerged.
Participants under age 60 with stage 1 hypertension who had a high 10-year risk of heart attack or stroke as calculated by the PCE tool faced a high 30-year risk of heart attack, stroke or heart failure using PREVENT – even if PREVENT had found their 10-year risk to be low.
The higher 30-year risk suggests blood pressure-lowering medication in addition to lifestyle changes might be beneficial in some cases, even if 10-year risks are low.
Dr. Paul Muntner said:
“There may be value in having a discussion between patients and health professionals about individual risks for having a heart attack, stroke or heart failure over both the next 10 years and the next 30 years, because early treatment to lower blood pressure has big effects on lowering the risks of developing heart disease over a person’s lifetime”.
Dr. Paul Muntner also said:
“All people, before starting blood pressure-lowering medications, should try lifestyle changes such as reducing salt intake, exercising more, losing weight if they are overweight and reducing alcohol consumption. Those are well-known lifestyle factors that can lower blood pressure.”
