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
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 tre…
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“Although there are some promising outcomes data,31 the effectiveness of artificial intelligence–based approaches has yet to be systematically studied.”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [31]
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From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [31]
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From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [31]
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Self-citation
- Authors
- Khan, S. S., Lloyd-Jones, D. M., Abdalla, M., Bello, N. A., Blyler, C. A., Carter, J., Commodore-Mensah, Y., Ferdinand, K. C., Johnson, H. M., Jones, D., Khera, A., Muntner, P., Schott, S., Shimbo, D., Smith, S. C., Taler, S. J., & Yang, E.
- ORCID
- Venue
- JACC
- Publisher
- Elsevier BV
- Published
- 2025-11
- Volume
- 86
- Issue
- 18
- Pages
- 1539-1559
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W4413785197
- Cited by
- 16
- References
- 16
- Citations by year
- 2026: 14 · 2025: 2
- FWCI
- 11.11
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Keywords
- quantitative risk assessment, blood pressure control, hypertension, primary prevention of cardiovascular disease, antihypertensive therapy initiation, Pooled Cohort Equations, stage 1 hypertension, shared decision-making, electronic health record decision support, guideline implementation
- MeSH terms
- Clinical Decision-Making, American Heart Association, Antihypertensive Agents, Blood Pressure, Cardiology, Cardiovascular Diseases, Humans, Hypertension, Primary Prevention, United States, Risk Assessment
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