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  • Title: Use of Risk Assessment to Guide Decision-Making for Blood Pressure Management in the Primary Prevention of Cardiovascular Disease
  • Society: American Heart Association and American College of Cardiology
  • Publish Date: August 28, 2025
  • Overview
  • Full-text

Video Transcription

Just published August 28th, 2025 The American Heart Association and The American College of Cardiology’s newest scientific statement on Use of Risk Assessment to Guide Decision-Making for Blood Pressure Management in the Primary Prevention of Cardiovascular Disease.

The goals of this scientific statement are to describe the revised framework for CVD risk assessment of the 2025 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults to initiate antihypertensive therapy,to discuss the evidence to support the selection of the more contemporary PREVENT equations for quantitative risk assessment, and to provide the rationale for using a PREVENT 10-year risk estimate of ≥7.5% for total CVD events for initiating BP-lowering drug therapy in stage 1 hypertension.

In today’s video, we’ll be just be going over Figure 1 which is the Comprehensive Risk-Based Framework According to Hypertension Stage and Risk Assessment for the Initiation of Antihypertensive Therapy According to the 2025 High Blood Pressure Guideline With the Use of the PREVENT-CVD Equation. For the full scientific statement, make sure to check it out on guidelinecentral.com. Let’s get started.

Starting with Stage 2 hypertension which the figure says is greater than equal to 140/90 mmHg. If the average BP is greater than or equal to 140/90, the figure states to initiate 2 or more antihypertensive drug therapy medications to lower BP for primary or secondary prevention of CVS (COR1)

Next are the indications for initiation of anti HTN drug therapy for Stage 1 hypertension which the figure says is 130-139 or 80-89 mmHg. First, the figure asks whether the patient is having existing clinical CVD? If yes, initiate antihypertensive drug therapy medications to lower BP for secondary prevention of CVD.

If not, the next question asks is the patient at increased short-term risk of CVS due to comorbidities of diabetes, or CKD? If yes, initiate antihypertensive drug therapy medications to lower BP for primary prevention of CVD.

If they don’t, then the next question asks, is the patient at increased short-term risk of CVD due to 10-year risk of CVD with PREVENT greater than or equal to 7.5%? If yes, initiate antihypertensive drug therapy medications to lower BP for primary prevention of CVD.

If the answer is no, the final question in the figure asks is the average systolic BP greater than or equal to 130 mmHg or diastolic BP greater than or equal to 80 mmHg after 3-6 months of lifestyle intervention attempts? If yes, initiate antihypertensive drug therapy medications to lower BP for primary prevention of CVD.

The figure also mentions a lifestyle approach for BP lowering and says, optimize lifestyle and psychosocial approaches according to Life’s Essential 8, stress reduction, and avoidance of substances that may increase blood pressure (eg, alcohol, over the counter pain medications, and herbal products.

And there you have it. Make sure to check out the full scientific statement from The American Heart Association and The American College of Cardiology and other related clinical decision support tools at guidelinecentral.com.

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