For years, deciding whether to take medication to lower high blood pressure was guided by a tool that estimated someone’s 10-year risk of having a heart attack or stroke.

However, new equations now also consider the 30-year risk for cardiovascular disease.

These new equations show that even if someone’s short-term risk is low, their long-term risk can still be high, according to a study published in the journal Hypertension.

Dr. Paul Muntner, the lead author of the study and a visiting professor at the University of Alabama at Birmingham, said, “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.”

High blood pressure, also known as hypertension, affects nearly half of U.S. adults. It occurs when the force of blood flowing through the arteries is too strong.

Over time, this can damage the blood vessels and lead to heart attack, stroke, heart failure, kidney disease, and other health issues.

Blood pressure readings have two numbers. The systolic pressure (the top number) measures the pressure in the arteries when the heart beats. The diastolic pressure (the bottom number) measures the pressure in the arteries between heartbeats.

Stage 1 hypertension is when the systolic pressure is between 130-139 mmHg or the diastolic pressure is between 80-89 mmHg. Stage 2 hypertension is when the systolic pressure is 140 mmHg or higher or the diastolic pressure is 90 mmHg or higher.

For adults with stage 2 hypertension, lifestyle changes and medication are recommended. For those with stage 1 hypertension, the 2017 guidelines from the American Heart Association (AHA) and the American College of Cardiology suggest considering both blood pressure levels and the risk of atherosclerotic cardiovascular disease (plaque buildup in the arteries) before starting medication.

Traditionally, the risk of cardiovascular disease was assessed using the Pooled Cohort Equations (PCEs), which estimate a person’s 10-year risk for heart attack and stroke based on factors like age, gender, race, cholesterol levels, blood pressure, diabetes, and smoking status.

However, these equations were based on data from the 1980s to the 2000s, and much has changed since then.

New research has shown that hypertension also increases the risk for heart failure, which was not considered in the PCEs. Additionally, the widespread use of statins, a type of cholesterol-lowering medication, has altered cardiovascular risks for many people.

In 2023, the AHA introduced a new set of cardiovascular risk prediction equations known as PREVENT.

These equations predict the risk of heart failure as well as plaque-related cardiovascular disease over the next 10 years for people aged 30 to 79 and over the next 30 years for those aged 30 to 59. The new tool also considers factors like kidney function, blood sugar levels, and the use of cholesterol-lowering medication.

It takes into account social determinants of health, such as income, education, employment, living conditions, and access to transportation. Notably, race is not included as a variable because it is considered a social construct, not a biological factor.

Dr. Nia Schwann Mitchell, an associate professor at Duke University School of Medicine, said, “PREVENT is more accurate because it uses more recent data.”

The new study compared 10-year cardiovascular disease risks using both the PCE and PREVENT equations for adults aged 30 to 79 with stage 1 hypertension. It also calculated the 30-year risk for adults aged 30 to 59 with high blood pressure.

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, the 30-year risk revealed a different story. Participants under age 60 with stage 1 hypertension who had a high 10-year risk using the PCE tool also faced a high 30-year risk using PREVENT, even if PREVENT showed a low 10-year risk.

The higher 30-year risk suggests that medication to lower blood pressure, in addition to lifestyle changes, might be beneficial in some cases, even if the 10-year risk is low.

“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,” Muntner said.

“Early treatment to lower blood pressure has big effects on lowering the risks of developing heart disease over a person’s lifetime.”

Medication isn’t the only way to lower blood pressure and might not always be necessary. Lifestyle changes such as reducing salt intake, exercising more, losing weight, and reducing alcohol consumption are well-known methods to lower blood pressure.

Not smoking, eating a healthier diet, getting enough sleep, lowering cholesterol levels, and reducing stress can also help.

“It’s much better to prevent something than to deal with the consequences of it later,” said Mitchell. “Hypertension is called ‘the silent killer’ because some people don’t feel it when their blood pressure is too high until it’s too late.”

Knowing their 30-year risk for a heart attack, stroke, or heart failure might motivate people to make these lifestyle changes or take blood pressure-lowering medication if needed.

“We need to be transparent about the predicted risk so patients have all the information and can be involved in the decision about what to do,” Muntner said. “Doctors can give advice, but patients are the ones ultimately making the decisions.”

If you care about heart health, please read studies that yogurt may help lower the death risks in heart disease, and coconut sugar could help reduce artery stiffness.

For more information about health, please see recent studies that Vitamin D deficiency can increase heart disease risk, and results showing vitamin B6 linked to lower death risk in heart disease.

The research findings can be found in Hypertension.

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