According to the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults, 10-year atherosclerotic cardiovascular disease (ASCVD) risk should now be used to determine antihypertensive medication treatment decisions for people with mild (Stage 1) hypertension.1 In creating the guidelines, experts reviewed recent randomized trials, observational studies, and modeling studies. This systematic review of the literature found that lowering systolic blood pressure (BP) to a target of <130 mm Hg may reduce the risk of several major outcomes including risk of heart attack, stroke, heart failure, and major cardiovascular events. Experts determined that lower treatment thresholds and targets will benefit patients who have a higher risk of BP-related complications, such as heart attack, heart failure, and stroke.1-4 Therefore, the guidelines endorse antihypertensive medication to lower blood pressure and as a primary prevention of cardiovascular disease for adults with an estimated 10-year ASCVD risk of 10% or higher AND Stage 1 hypertension (130/80 mm Hg to <140/90 mm Hg).4
About ASCVD Risk
ASCVD 10-year risk is the absolute risk estimation of nonfatal heart attack, nonfatal stroke, fatal stroke, and fatal coronary heart disease.4-8 It estimates the 10-year risk of these outcomes based on analyses of large amounts of population data of people with a variety of characteristics and risk factors.
ASCVD risk can be calculated by doctors or an online calculator: ASCVD Risk Estimator Plus.4,8 The online calculator was recently updated to include the Million Hearts Longitudinal Assessment tool, which allows doctors to adjust ASCVD risk score factoring in changes to a person’s risk factors over time. For an initial ASCVD 10-year risk, only these factors are used in the calculation:7,8
- Systolic Blood Pressure
- Total Cholesterol
- High-Density Lipoprotein (HDL) Cholesterol
- History of Diabetes
- Smoking Status
- On Hypertension Treatment
- Reboussin DM, Allen NB, Griswold ME, et al. Systematic review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2017.
- Cifu AS, Davis AM. Prevention, detection, evaluation, and management of high blood pressure in adults. JAMA 2017; 318 (21): 2132-2134.
- Wright JT, Jr., Williamson JD, Whelton PK, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 2015; 373 (22): 2103-2116.
- Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2017.
- Karmali KN, Goff DC, Jr., Ning H, Lloyd-Jones DM. A systematic examination of the 2013 ACC/AHA pooled cohort risk assessment tool for atherosclerotic cardiovascular disease. J Am Coll Cardiol 2014; 64 (10): 959-968.
- Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63 (25 Pt B): 2889-2934.
- Goff DC, Jr., Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 129 (25 Suppl 2): S49-73.
- ASCVD Risk Estimator Plus. American College of Cardiology. Nov 2017; http://tools.acc.org/ASCVD-Risk-Estimator-Plus/#!/calculate/estimate/. Accessed 1/21/2018.