• Shouling Wu, Yanxiu Wang, Jiangshui Wang, Jun Feng, Furong Li, Liming Lin, Chunyu Ruan, Zhifang Nie, Jinwei Tian, and Cheng Jin.
• Department of Cardiology, Kailuan General Hospital, Tangshan, 063000, China.
• Bmc Med. 2025 Feb 11; 23 (1): 8080.

BackgroundPreventing cardiovascular disease (CVD) in adults with hypertension is essential, but it remains uncertain whether optimizing modifiable factors can eliminate the excess CVD risk associated with new-onset hypertension.MethodsIn this prospective cohort study, 29,597 adults with new-onset hypertension and no prior CVD (from 2006-2016 surveys) were each matched by age and sex to a normotensive control. Eight modifiable factors were assessed using the American Heart Association's Life's Essential 8 algorithm. We followed participants for incident CVD until December 2020, estimating 10-year and lifetime (age 25-95) CVD risks using the Fine-Gray competing risks model.ResultsOver a median follow-up of 9.81 years, adults with new-onset hypertension had higher 10-year (8.97% vs. 6.31%) and lifetime CVD risks (45.55% vs. 34.98%) compared to normotensive controls. After adjusting for age, sex, and other unmodifiable factors, each additional favorable factor was associated with a stepwise reduction in CVD risk (P-trend < 0.05). Hypertensive participants with four or more favorable factors had a 17% lower 10-year CVD risk (HR 0.83; 95% CI 0.72-0.97) and a similar lifetime CVD risk (HR 0.90; 95% CI 0.78-1.05) compared to normotensive controls. Notably, the protective effect was weaker among those with early-onset (before age 45) hypertension than those with later-onset (age ≥ 60) hypertension (P-interaction < 0.05).ConclusionsIn adults with new-onset hypertension, maintaining four or more modifiable factors at favorable levels was associated with a CVD risk comparable to that of normotensive individuals. However, young hypertensive adults may require more aggressive interventions to mitigate CVD risk.© 2025. The Author(s).

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