August 28, 2025Journal of the American College of Cardiology
Use of Risk Assessment to Guide Decision-Making for Blood Pressure Management in the Primary Prevention of Cardiovascular Disease: A Scientific Statement From the American Heart Association and American College of Cardiology
Why the study?
The 2025 High Blood Pressure Guideline updated the recommended risk model to the Predicting Risk of Cardiovascular Disease Events equations and defined a new risk threshold in stage 1 hypertension.
Key Points
- The aim is to summarize the evolving guidelines on risk assessment for initiating antihypertensive therapy in cardiovascular disease prevention.
- Incorporated the Predicting Risk of Cardiovascular Disease Events equations for risk calculation.
- Defined a new threshold of ≥7.5% for 10-year cardiovascular disease risk.
- Discussed practical implementation strategies for clinicians and patients.
- Updated guidelines recommend initiating therapy based on the new risk threshold of ≥7.5%.
- Evidence indicates improved patient outcomes with the new risk assessments.
- Highlighted gaps in awareness and treatment need innovative strategies for better adherence.
Structured PICO
P
Population
Patients with stage 1 hypertension in the primary prevention of cardiovascular disease
I
Intervention
Risk assessment using the Predicting Risk of Cardiovascular Disease Events (PREVENT) equations to guide initiation of antihypertensive drug therapy
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The most important highlight is that [the statement] tried to address any concerns that fewer people would be treated because of using the PREVENT equations. When it came out without having a threshold [for treatment], it was hard to interpret how it could get applied.”
“The PREVENT equations are the first risk tool that combines cardiovascular, kidney and metabolic health measurements to support primary prevention-focused treatment decisions. They represent the best science and evidence to rigorously and accurately estimate CVD risk today. The most important message for clinicians and patients is that risk from high blood pressure is modifiable. And the goal of using the PREVENT equations is to tailor and personalize preventive care so we can better support our patients to achieve marked improvements that result in longer, healthier lives.”
“The new PREVENT equations are based on more modern, more contemporary datasets, therefore, they are a better tool than the past risk models. The new PREVENT equations are different also because they include information about kidney disease and metabolic disease, all of which are linked to blood pressure levels. The PREVENT equations are more comprehensive and will give a stronger and more accurate risk prediction for our patients, allowing us to personalize care.”
Implication
This AHA/ACC scientific statement provides the rationale and practical guidance for using the PREVENT equations and a ≥7.5% 10-year CVD risk threshold to guide antihypertensive therapy initiation in primary prevention.
Abstract
Risk assessment plays a central role in the primary prevention of cardiovascular disease. The 2017 High Blood Pressure Clinical Practice Guideline incorporated quantitative risk assessment for the first time to guide the initiation of antihypertensive drug therapy and recommended calculation of 10-year risk of atherosclerotic cardiovascular disease with the Pooled Cohort Equations. Although the 2025 High Blood Pressure Guideline reaffirmed this overarching paradigm for risk-based initiation of antihypertensive drug therapy, it updated the recommended risk model to the Predicting Risk of Cardiovascular Disease Events equations, which estimate 10-year risk of total cardiovascular disease (including atherosclerotic cardiovascular disease and heart failure), and defined a new risk threshold for initiation of antihypertensive therapy in patients with stage 1 hypertension. This American Heart Association/American College of Cardiology scientific statement summarizes the rationale to recommend the use of the Predicting Risk of Cardiovascular Disease Events equations, the evidence base for the new threshold of 10-year risk of cardiovascular disease of ≥7.5%, and the population-level implications of these revised recommendations. This scientific statement also offers practical advice for implementing risk assessment as the first step in the comprehensive approach to hypertension management with shared decision-making between patients and clinicians. Remaining gaps in awareness and treatment of hypertension underscore the need for innovative strategies to improve implementation of and adherence to risk-based guideline recommendations, including automation of risk assessment in electronic health records, decision-support aids, and refinement of risk assessment, to equitably improve the initiation of antihypertensive drug therapy, blood pressure control, and outcomes.
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Cite This Study
Khan et al. (2025) conducted a review in Cardiovascular disease primary prevention and hypertension. Predicting Risk of Cardiovascular Disease Events equations vs. Pooled Cohort Equations was evaluated. The AHA/ACC scientific statement recommends using the Predicting Risk of Cardiovascular Disease Events equations and a 10-year CVD risk threshold of ≥7.5% to guide antihypertensive therapy initiation.