A new Hypertension Study analyzing updated 2025 guidelines shows that using the PREVENT risk score reduces immediate drug therapy recommendations for 11.4% of adults ages 65 to 79 who have untreated stage I hypertension.
New Guidelines Reduce Immediate Drug Use
A Hypertension Study published in Annals of Internal Medicine examines data from about 3,000 adults ages 65 to 79, collected between 2013 and 2020. Researchers report that 11.4% of those with untreated stage I hypertension no longer qualify for immediate medication under the updated 2025 guidance.
The revised recommendations come from the American Heart Association and the American College of Cardiology. They shift focus from age-based treatment to individualized cardiovascular risk assessment.
“In the past, many adults age 65 and older with stage I hypertension would often have been considered candidates for medication based mainly on age,” said Dr. Sridhar Mangalesh, a resident physician at Jacobi Medical Center in New York and the study’s first author.
He said the study aims to identify which patients still need immediate therapy and which may safely delay medication.
PREVENT Score Refines Risk Assessment
The PREVENT score estimates a person’s 10-year risk of developing major cardiovascular disease by combining factors such as age, blood pressure, cholesterol levels, kidney function, diabetes status and smoking history.
Researchers in the Hypertension Study find that patients reclassified as ineligible for immediate treatment are often women ages 65 to 68, nonsmokers, and individuals with moderate cholesterol and blood pressure levels. Their estimated risk scores range from 4.8% to 7.4%.
Under earlier 2017 guidelines, adults in this age group often qualified for medication based on age alone or if their 10-year atherosclerotic cardiovascular disease risk exceeded 10%.
Unlike older models, PREVENT incorporates kidney and metabolic health into its calculations, offering a broader view of cardiovascular risk, said Dr. Laura Mayeda, a clinical assistant professor at the University of Washington School of Medicine.
Lifestyle Changes Gain Priority Before Medication
The updated 2025 guidance emphasizes lifestyle interventions as a first step for lower-risk patients. These include reduced salt intake, heart-healthy diets and regular physical activity.
“The 2025 guideline places strong emphasis on lifestyle changes across a wide range of patients,” said Dr. Michael Nanna, an assistant professor at Yale School of Medicine and a study co-author. He added that patients may undergo a three- to six-month trial of lifestyle changes before starting medication.
Experts say the shift is unlikely to dramatically alter clinical practice because most patients already receiving treatment still meet eligibility criteria due to higher risk profiles or existing conditions.
However, the PREVENT score becomes especially useful in borderline cases, Mangalesh said, helping clinicians avoid unnecessary medication in lower-risk individuals.
The updated approach could delay drug therapy for some patients who successfully improve their health through lifestyle changes, Mayeda said, potentially postponing medication for several years.
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