p.9 抽出テキスト
CLINICAL STATEMENTS AND GUIDELINES September 16, 2025 Circulation. 2025;152:e114–e218. DOI: 10.1161/CIR.0000000000001356 e122 CVD (MI, stroke, and HF), which is especially relevant as trials evaluating antihypertensive therapies and BP thresh olds have focused on major adverse cardiovascular events (MACE) as the primary outcome. The PCEs are applica ble to adults aged 40 to 79 years who are not on statin therapy. In contrast, PREVENT is applicable to adults aged 30 to 79 years and includes statin therapy as a predictor, making it more broadly applicable to guide preventive de cisions regarding antihypertensive therapy. PREVENT in corporates measures of kidney function, as chronic kidney disease (CKD) is an important end-organ manifestation of hypertension and is associated with higher CVD risk. PRE VENT includes the integration of place-based social risk (social deprivation index [SDI]), as the burden of hyperten sion is higher among those who reside in neighborhoods with higher deprivation. As a result of these changes, model performance for PREVENT is superior to PCEs. In a contemporary sample of 3.3 million US adults, PCEs over predicted risk by 2-fold while PREVENT had excellent calibration, even when examined by race and ethnic group. Taken together, the writing committee recommends the use of PREVENT to estimate 10-year risk for CVD for adults with hypertension without clinical CVD in determining the BP threshold for initiation of therapies (Section 5.2.1, “Ini tiation of Pharmacological BP Treatment in the Context of Overall CVD Risk”) and the BP goal for treatment (Section 5.2.7, “BP Goal for Patients With Hypertension”). In developing this guideline, the writing committee reviewed previously published guidelines and related sci entific statements. Table 2 contains a list of AHA/ACC publications deemed pertinent to this writing effort and is intended for use as a resource. 1.5 Class of Recommendations and Level of Evidence The Class of Recommendation (COR) indicates the strength of recommendation, encompassing the estimat ed magnitude and certainty of benefit in proportion to risk. The Level of Evidence (LOE) rates the quality of sci entific evidence supporting the intervention on the basis of the type, quantity, and consistency of data from clinical trials and other sources (Table 3).28 1.6 Abbreviations Abbreviations Meaning/Phrase ABPM ambulatory blood pressure monitoring ACEi angiotensin-converting enzyme inhibitor AD aortic disease AF atrial fibrillation AKI acute kidney injury AOBP automated office blood pressure ARB angiotensin receptor blocker Abbreviations Meaning/Phrase ASCVD atherosclerotic cardiovascular disease BB beta blocker BMI body mass index BP blood pressure CCB calcium channel blocker CCD chronic coronary disease CKD chronic kidney disease CKM cardiovascular-kidney-metabolic COR class of recommendation CPAP continuous positive airway pressure CVD cardiovascular disease DASH Dietary Approaches to Stop Hypertension DBP diastolic blood pressure eGFR estimated glomerular filtration rate EHR electronic health record GDMT guideline-directed medical therapy GLP-1 glucagon-like peptide-1 HBPM home blood pressure monitoring HCTZ hydrochlorothiazide HDP hypertensive disorders of pregnancy HF heart failure HFpEF heart failure with preserved ejection fraction HFrEF heart failure with reduced ejection fraction HbA1c hemoglobin A1c HIT health information technology HR hazard ratio ICH intracerebral hemorrhage IV intravenous LOE level of evidence MACE major adverse cardiovascular event MI myocardial infarction MRA mineralocorticoid receptor antagonist OH orthostatic hypotension OSA obstructive sleep apnea PAD peripheral artery disease PCE pooled cohort equation RAS renin-angiotensin-system RAASi renin-angiotensin-aldosterone system inhibitor RCT randomized controlled trial RDN renal denervation SBP systolic blood pressure SDOH social determinants of health SGLT2i sodium-glucose cotransporter-2 inhibitor SPC single-pill combination T2D type 2 diabetes TIA transient ischemic attack US United States Downloaded from http://ahajournals.org by on October 7, 2026