Better at identifying who genuinely needs treatment — and who can safely avoid it.
For millions of Americans living with elevated blood pressure, the question of whether to start medication has long been answered with a blunt instrument. Now, a new scientific statement from the American Heart Association and the American College of Cardiology is making the case for a sharper one.
The statement, published simultaneously in Circulation, Hypertension, and JACC on August 29, 2025, endorses the use of the PREVENT™ equations — a risk-calculation tool the AHA developed in 2023 — as the preferred method for estimating cardiovascular disease risk in adults with high blood pressure. It arrives as a companion document to the newly released 2025 AHA/ACC High Blood Pressure Guideline, which formally recommends PREVENT™ for personalizing treatment decisions.
The equations themselves are built on data from more than six million diverse American adults and can project both 10-year and 30-year risk for total cardiovascular disease, including atherosclerotic cardiovascular disease and heart failure, in people between the ages of 30 and 79 who have no prior CVD history. What sets PREVENT™ apart from its predecessor — the Pooled Cohort Equations, which estimated only atherosclerotic risk — is the breadth of what it measures. The calculator incorporates body mass index, blood pressure readings, diabetes status, kidney function, metabolic health markers, and even a zip code-based social deprivation index. The result is a risk portrait that reflects the full complexity of a patient's life, not just their cholesterol numbers.
The practical stakes are clearest for people with stage 1 hypertension — defined as a systolic blood pressure between 130 and 139 mm Hg, or a diastolic reading between 80 and 89 mm Hg. Under the 2025 guideline, those patients should begin antihypertensive medication alongside lifestyle changes if their PREVENT™-calculated 10-year CVD risk reaches or exceeds 7.5 percent. That threshold is a meaningful clinical line: below it, lifestyle modification alone may suffice; above it, the evidence supports adding a pill.
One concern that shadowed the guideline's development was whether the new risk threshold would effectively shrink the pool of patients recommended for medication — leaving some high-risk individuals untreated. The scientific statement addresses this directly. The total number of people who qualify for antihypertensive therapy under the 2025 guideline is comparable to the number under the 2017 guideline. The difference is not in the headcount but in the accuracy of the sorting: PREVENT™ is better at identifying who genuinely needs treatment and who can safely avoid it.
Daniel W. Jones, dean and professor emeritus at the University of Mississippi School of Medicine and chair of the 2025 guideline writing committee, described the shift as a matter of using better data. The PREVENT equations draw on more contemporary datasets and fold in kidney and metabolic disease — conditions tightly linked to blood pressure — in ways the older models did not. The result, he argued, is a more comprehensive and reliable prediction for each patient.
Sadiya S. Khan, the Magerstadt Professor of Cardiovascular Epidemiology at Northwestern's Feinberg School of Medicine and chair of the scientific statement writing group, framed the tool's significance in terms of what it makes possible. PREVENT™ is the first risk instrument to combine cardiovascular, kidney, and metabolic health data in a single calculation aimed at primary prevention. The goal, she said, is not just to count risk but to act on it — to tailor care so that patients can live longer, healthier lives. Crucially, she emphasized that the risk posed by high blood pressure is not fixed. It can be changed.
The scientific statement stops short of making direct treatment recommendations — that is the role of the clinical guidelines — but it lays out the evidence base, explains the rationale behind the 7.5 percent threshold, and offers practical guidance for clinicians trying to weave PREVENT™ into routine care. The writing group also identifies areas where more research is needed.
For clinicians, the next practical challenge is integration: getting the PREVENT™ calculator embedded into electronic health record systems so that risk scoring becomes a routine part of every hypertension visit rather than an extra step. That infrastructure question will likely determine how quickly the guideline's promise translates into changed outcomes at the bedside.
Notable Quotes
The PREVENT equations are more comprehensive and will give a stronger and more accurate risk prediction for our patients, allowing us to personalize care.— Daniel W. Jones, M.D., chair of the 2025 High Blood Pressure Guideline writing committee, University of Mississippi School of Medicine
The most important message for clinicians and patients is that risk from high blood pressure is modifiable — the goal is to tailor preventive care so patients can achieve longer, healthier lives.— Sadiya S. Khan, M.D., chair of the scientific statement writing group, Northwestern's Feinberg School of Medicine
The Hearth Conversation Another angle on the story
What's actually new here — haven't doctors always tried to weigh risk before prescribing blood pressure medication?
They have, but the tools they used were narrower. The old model estimated only one type of cardiovascular risk and drew on older, less diverse data. PREVENT™ casts a wider net and reflects who Americans actually are today.
What does it mean in practice that the tool includes a zip code-based social deprivation index?
It means two patients with identical blood pressure readings might get different risk scores if one lives in a neighborhood with limited healthcare access, poor food environments, or chronic stress. The biology doesn't happen in a vacuum.
The 7.5 percent threshold — where does that number come from?
It's the point at which the evidence shows medication adds meaningful benefit over lifestyle changes alone. Below that line, the risk of side effects and the burden of a daily pill may outweigh the gain. Above it, the math shifts.
There was concern the new guideline would leave more people unmedicated. Has that been resolved?
The statement addresses it head-on. The total number of people recommended for medication is roughly the same as under the 2017 guideline. The difference is that the new tool is better at identifying which individuals those should be.
What does it mean that PREVENT™ includes kidney and metabolic health?
Kidney function and metabolic conditions like diabetes aren't just comorbidities — they interact directly with blood pressure and cardiovascular risk. Leaving them out of the calculation was always an incomplete picture.
Is this statement telling doctors what to do, or just summarizing the evidence?
It's the latter. Scientific statements map the terrain; guidelines issue the directions. This one explains why the 2025 guideline made the choices it did and points toward where the research still has gaps.
What's the thing that has to happen next for this to actually change patient care?
The calculator needs to live inside the electronic health record — one click, not a separate website. Until that's routine, the best tool in the world sits unused during a twelve-minute appointment.