Hypertension treatment and risk of cardiovascular disease or mortality across risk equations: results from SPRINT

The 2025 AHA/ACC blood pressure (BP) management guidelines recommend BP treatment for 10-year cardiovascular disease (CVD) ≥7.5% from the PREVENT equation, replacing the prior pooled cohort equations (PCE). We examined associations between risk in PCE and PREVENT and a composite of CVD or cardiovascular death in SPRINT. Among 1794 participants, 477 (26.6%) were at low risk in both, 119 (6.6%) were high-risk in PREVENT only, 89 (5.0%) were high-risk in PCE only, and 1109 (61.8%) were high-risk in both. Those at high risk in both equations receiving intensive treatment had a lower risk of the primary outcome [hazard ratio (HR): 0.46, 95% confidence interval (CI): 0.24, 0.89]. Intensive treatment did not affect the risk of any outcomes for those at high-risk in PREVENT only or PCE only due to low event rates. These findings confirm the neutrality of the change from PCE to PREVENT for BP treatment recommendations.