New risk calculator may reduce number of patients suggested for BP-lowering medication
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Key takeaways:
- Those with stage 1 hypertension had lower 10-year ASCVD risk when estimated using new PREVENT equations.
- Use of PREVENT rather than the Pooled Cohort Equations may reduce antihypertensive drug use as a result.
Ten-year atherosclerotic CVD risk for people with stage 1 hypertension was substantially lower when estimated with the new PREVENT equations vs. the Pooled Cohort Equations, researchers reported.
This finding may indicate that fewer patients assessed using the PREVENT equations would be subsequently prescribed antihypertensive medication for primary prevention, according to research published in Hypertension, though the researchers suggested that 30-year risk can be included in such decisions.
“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,” Paul Muntner, PhD, MHS, FAHA, visiting professor in the department of epidemiology at the University of Alabama at Birmingham, said in a press release. “Experts who develop cardiovascular disease 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.”
The new PREVENT equations
The American Heart Association first unveiled its new PREVENT equations to predict long-term absolute risk tied to CV-kidney-metabolic syndrome at its Scientific Sessions in November.
As Healio previously reported, the PREVENT equations were developed using real-world contemporary data from more than 6 million adults and include HF risk in addition to risk for MI and stroke; omit race from CVD clinical care algorithms; include kidney function on top of traditional CVD risk factors for heart disease; and include social determinants of health, glucose and kidney function, when clinically available.
When used at age 30 years, the equations are designed to enable 10- and 30-year total CV risk estimation and aid clinical decision-making.
“Higher systolic BP levels increase the risk of heart failure, an outcome not included in the Pooled Cohort Equations. Also, the Pooled Cohort Equations were developed using data from the 1980s to the 2000s and may not correctly estimate risk in contemporary cohorts,” the researchers wrote in the study background.
For the present study, Muntner and colleagues used National Health and Nutrition Examination Survey data from 2013 to 2020 from 1,703 adults (mean age, 50 years; 55% men) to assess 10-year ASCVD risk estimated using the Pooled Cohort Equation compared with 10-year ASCVD and total CVD risk estimated by the PREVENT equations.
Participants were without self-reported CVD at baseline, and all had stage 1 hypertension, defined as systolic BP of 130 mm Hg to 139 mm Hg or diastolic BP of 80 mm Hg to 89 mm Hg.
The average 10-year ASCVD risk was 5.4% when researchers used the Pooled Cohort Equations and 2.9% with the PREVENT equations.
With the Pooled Cohort Equations, the proportion of participants with a 10-year ASCVD risk of 10% to less than 15% was 8.1%, and 7.8% had a risk of at least 15%. In comparison, 3% had a 10-year ASCVD risk of 10% to less than 15% when using the PREVENT equations, and only 0.3% had a risk of at least 15%.
The researchers noted that no participants had both a 10-year ASCVD risk of 10% or more on the PREVENT equations and a risk less than 10% on the Pooled Cohort Equations. However, 12.5% had a 10-year ASCVD risk of 10% or more on the Pooled Cohort Equations and a less than 10% risk on the PREVENT equations.
Moreover, the average 10-year total CVD risk was lower with the PREVENT equations compared with the Pooled Cohort Equations across all subgroups.
Antihypertensive initiation may decline for some
“The current study has potential implications for clinical practice and public health,” the researchers wrote. “In the current study, a substantially smaller percentage of U.S. adults with stage 1 hypertension had 10-year predicted ASCVD risk 10% when estimated by the PREVENT equations vs. the Pooled Cohort Equations. ... This indicates that fewer U.S. adults with stage 1 hypertension may be recommended antihypertensive medication initiation if 10-year predicted ASCVD risk was estimated using the PREVENT equations instead of the Pooled Cohort Equations.
“The PREVENT equations demonstrated good calibration for ASCVD and total CVD risk in contemporary cohorts, suggesting that U.S. adults with 10-year predicted ASCVD and CVD risk < 10% should have low event rates,” they wrote.
However, Muntner said in the release: “Many people with stage 1 high blood pressure who are not likely to have a heart attack, stroke or heart failure over the next 10 years may have a high risk over the next 30 years. People may want to discuss this with their doctors and consider starting antihypertensive medication to reduce their risk of heart attack, stroke and heart failure across their lifetime even if they have a low short-term risk.”
Reference:
- 30-year risk of cardiovascular disease may help inform blood pressure treatment decisions. https://newsroom.heart.org/news/30-year-risk-of-cardiovascular-disease-may-help-inform-blood-pressure-treatment-decisions. Published July 15, 2024. Accessed July 15, 2024.
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