PreventCVD — HTN & Lipid Management

PreventCVD — Hypertension & Dyslipidemia Management · 2026 ACC/AHA · 2025 AHA/ACC · JNC 8 · ADA 2024

PreventCVD

Clinical Decision Support

2025 AHA/ACC HTN 2026 ACC/AHA Lipids ADA 2024 JNC 8 ESH/ESC 2023

Follow-Up Assessment Details

BP trend, medication timeline, side effects, and follow-up labs

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BBP Trend Since Last Visit

Previous SBP mmHg

prev SBP

Previous DBP mmHg

prev DBP

Blood Pressure Readings

Average of ≥2 properly measured readings on ≥2 occasions

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📏 Proper Measurement Technique

Patient seated quietly for ≥5 min, feet flat, back supported. Arm at heart level. Validated electronic device. Average of 2 readings taken 1–2 minutes apart. Confirm with out-of-office readings (home BP or 24-hour ABPM) before initiating therapy.

AAverage BP Reading

Systolic BP mmHg *

SBP

Diastolic BP mmHg *

DBP

BOut-of-Office BP If available — helps confirm white coat vs. masked HTN

Home SBP Average mmHg

Home DBP Average mmHg

📲 2025 AHA/ACC: Cuffless Devices Not Recommended

Reliance on cuffless devices, including smartwatches and wrist-based sensors, for accurate BP measurements should be avoided for clinical decision-making. Use a validated upper-arm cuff device with standardized technique.

CPatient Demographics

Age years *

Sex *

Resting HR bpm

Height inches

Weight lbs

BMI kg/m² (auto)

DAuto-Staged BP Category Set from readings — override if needed

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Normal

<120/<80

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Elevated

120–129/<80

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Stage 1

130–139/80–89

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Stage 2

≥140/≥90

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Crisis

≥180/≥120

🚨 HYPERTENSIVE CRISIS — Immediate Evaluation Required

BP ≥180/120 mmHg. Assess for target organ damage (headache, vision changes, chest pain, dyspnea, neurological symptoms, hematuria). Hypertensive Emergency (with organ damage): IV therapy, ICU admission. Severe Hypertension without TOD (no organ damage): Oral therapy, close follow-up within 24–72 hours.

Comorbidities & Compelling Indications

Drive first-line drug class selection — critical for individualized therapy

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💡 Why Compelling Indications Matter

2025 AHA/ACC and JNC 8: Certain comorbidities mandate specific drug classes regardless of BP stage — these are "compelling indications." For example, post-MI patients require beta-blockers + ACEi/ARB, CKD patients require ACEi/ARB to slow progression, and heart failure patients require specific combinations. These override standard monotherapy selection.

Diabetes (Type 1 or 2)?

CKD Stage

Heart Failure?

Coronary Artery Disease?

Prior Stroke / TIA?

Atrial Fibrillation?

COPD / Asthma?

Peripheral Artery Disease?

Gout / Hyperuricemia?

Aortic Aneurysm / Dissection?

Pregnancy / Planning?

Frailty / High Fall Risk? (Age ≥75 esp.)

Liver Disease?

BLifestyle & Risk Factors

Current Smoker?

PREVENT 10-Year ASCVD Risk %

Enter from AHA PREVENT Calculator ↗

Laboratory Values

Guides drug selection, contraindications, and goal adjustment

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eGFR mL/min/1.73m²

Serum K⁺ mEq/L

Serum Cr mg/dL

Sodium mEq/L

Urine ACR mg/g

Fasting Glucose mg/dL

HbA1c %

TSH mIU/L

Uric Acid mg/dL

ALT / AST U/L (higher of two)

📊 AHA PREVENT — Estimated 10-Year Total CVD Risk

Validate with AHA Calculator ↗

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Enter required values to calculate

Requires: age, sex, SBP, total cholesterol, HDL, BMI, diabetes, smoking status

Calculation Inputs Used

Based on Khan SS et al., Circulation 2024;149:e430-e450. Base model (10-yr total CVD). Validated ages 30–79. This is an estimate — verify with the official AHA PREVENT calculator for clinical decisions.

ADrug Allergies & Intolerances

Select all drug classes the patient has had allergies or intolerances to. These will be flagged in the medication section.

ACE Inhibitor

Cough, allergy

ARB

Hyperkalemia, allergy

DHP CCB

Edema, flushing

Non-DHP CCB

Bradycardia, constipation

Thiazide Diuretic

Gout, hypoK, sulfa

Beta-Blocker

Bronchospasm, fatigue

MRA / Spironolactone

Gynecomastia, hyperK

Loop Diuretic

Electrolyte loss, ototoxicity

Alpha-Blocker

Orthostatic hypotension

Central Agent

Sedation, rebound HTN

Hydralazine

Lupus-like, tachycardia

Minoxidil

Fluid retention, hirsutism

SGLT2 Inhibitor

UTI, DKA risk

ACEi Angioedema / Serious Allergy

🔴 ACEi Angioedema / Anaphylaxis

Angioedema, anaphylaxis — 2-17% ARB cross-reactivity; avoids entire RAAS class

Sulfonamide (Sulfa) Allergy

Sulfa Allergy

Sulfonamide antibiotic allergy (rash, hives)

Severe / Anaphylaxis

Anaphylaxis, angioedema, SJS/TEN to sulfa

Current Antihypertensive Therapy

Determines whether to initiate, intensify, or add agents

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BCurrent Drug Classes at Maximum Tolerated Dose (check all that currently apply — treatment status is determined automatically)

ACE Inhibitor🔴 Allergylisinopril (Prinivil), ramipril (Altace), enalapril (Vasotec)

ARB — cannot combine with ACEi🔴 Allergylosartan (Cozaar), valsartan (Diovan), olmesartan (Benicar)

DHP Calcium Channel Blocker🔴 Allergyamlodipine (Norvasc), nifedipine XL (Procardia XL), felodipine

Non-DHP CCB caution: avoid with BB🔴 Allergydiltiazem (Cardizem CD), verapamil (Calan SR, Verelan)

Thiazide Diuretic🔴 Allergychlorthalidone (Thalitone), HCTZ (HydroDIURIL)

Beta-Blocker🔴 Allergymetoprolol succ. (Toprol-XL), carvedilol (Coreg), bisoprolol (Zebeta)

Aldosterone Antagonist (MRA)🔴 Allergyspironolactone (Aldactone), eplerenone (Inspra)

Loop Diuretic🔴 Allergyfurosemide (Lasix), torsemide (Demadex), bumetanide (Bumex)

Alpha-Blocker🔴 Allergydoxazosin (Cardura), terazosin (Hytrin), prazosin (Minipress)

Central Agent🔴 Allergyclonidine (Catapres), methyldopa (Aldomet)

Hydralazine (Apresoline)🔴 Allergydirect vasodilator — use with beta-blocker

Minoxidil (Loniten)🔴 Allergypotent vasodilator — requires BB + diuretic

SGLT2 Inhibitor🔴 Allergyempagliflozin (Jardiance), dapagliflozin (Farxiga), canagliflozin

⚠ Side Effects Reported at This Visit Select any symptoms the patient reports for each medication

CDose Adequacy Enter current doses to check for undertitration before recommending add-on therapy

Dose fields appear when the corresponding medication is checked above.

ACEi / ARB dose mg/day

CCB dose mg/day (amlodipine eq.)

Thiazide dose mg/day (chlorthal. eq.)

BB dose mg/day (metoprolol eq.)

BB type (if on BB)

MRA dose mg/day (spiro eq.)

Medication Adherence

White Coat Effect Suspected?

Secondary Hypertension Screening

Consider if young, resistant, or unusual features present

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🔍 When to Suspect Secondary HTN

Age <30 with no family history, resistant HTN on ≥3 agents, hypokalemia (especially spontaneous or out of proportion to diuretic use) → evaluate for primary aldosteronism, onset after age 55 (renal artery stenosis), cushingoid features, or episodic HTN with diaphoresis (pheochromocytoma).

Resistant HTN?

OSA Diagnosed / Suspected?

BSecondary Cause Clues

Bilateral RAS suspected (ACEi/ARB CONTRAINDICATED)Bilateral bruit, flash pulmonary edema, Cr rise on ACEi, resistant HTN in both kidneys

Unilateral RAS suspected (ACEi/ARB generally safe — may benefit)Unilateral bruit, asymmetric kidney size, HTN in young patient

Pheochromocytoma suspectedEpisodic HTN, headache, sweating, palpitations

Primary Aldosteronism suspectedHypokalemia, adrenal incidentaloma, resistant HTN

Thyroid disease suspectedHypothyroidism (diastolic HTN) / Hyperthyroidism (systolic HTN)

Cushing syndrome suspectedCentral obesity, striae, moon facies, buffalo hump

Coarctation of aorta suspectedYoung patient, radio-femoral delay, rib notching

CPotentially Interfering Substances Common causes of drug-induced & resistant HTN

⚠️ Identify Before Escalating Therapy

These agents can raise BP 3–20 mmHg and blunt antihypertensive response. Removing them is a higher-yield intervention than adding a new drug. Check all that apply.

NSAIDs / COX-2 inhibitorsibuprofen, naproxen, celecoxib — raise BP 3–5 mmHg, blunt RAAS

Oral contraceptives / HRTestrogen-containing — raise BP via renin-angiotensin activation

Stimulants / decongestantscocaine, amphetamines, pseudoephedrine, methylphenidate

SNRIs / TCAsvenlafaxine, duloxetine — norepinephrine elevation raises BP

Systemic corticosteroidsprednisone, dexamethasone — sodium retention, volume expansion

Calcineurin inhibitorscyclosporine, tacrolimus — vasoconstriction, sodium retention

Lifestyle Counseling & Note Options

Document counseling provided today

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ACounseling Provided Today

DASH diet counselingHigh fruits/vegetables, low sodium, low saturated fat

Sodium restriction counselingGoal <2.3 g/day — can reduce SBP 4–8 mmHg

Exercise prescription≥150 min/week moderate aerobic — reduces SBP 4–9 mmHg

Weight loss counseling~1 mmHg SBP per 1 kg lost

Alcohol reduction counselingLimit ≤2 drinks/day M, ≤1 drink/day F

Smoking cessation counselingSmoking dramatically increases CVD risk

Stress reduction / sleepMindfulness, sleep hygiene, relaxation techniques

Additional Notes Clinician free-text

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Hyperlipidemia Management

Lipid panel, statin therapy, risk enhancers, CAC score — click to expand

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Hyperlipidemia Management

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Patient Demographics

Age is required for guideline-based lipid management recommendations

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Age years *

Sex *

Diabetes

Smoking

CKD Stage

eGFR mL/min

ℹ️ Note: Age, sex, diabetes status, and CKD are used to determine the correct management group, statin intensity, LDL-C goal, and CVD risk tier per the 2026 ACC/AHA Dyslipidemia Guideline. These fields sync with the Hypertension tab if you switch between modules.

CVD Risk & Lipid Values

Core inputs — drives all downstream recommendations

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ℹ️ How to find these values

ASCVD Risk: Use the AHA PREVENT calculator (professional.heart.org) — the 2026 ACC/AHA guideline replaces PCE with the PREVENT-ASCVD equation for 10-year atherosclerotic CVD risk estimation. Lipids: Non-fasting lipid panel is acceptable for screening; fasting preferred when accurate triglyceride level is needed (TG ≥400 mg/dL) or when familial dyslipidemia is suspected. Established ASCVD: Prior MI, ACS, stable/unstable angina, coronary or other arterial revascularization, ischemic stroke, TIA, PAD, carotid artery stenosis, aortic atherosclerotic disease.

A10-Year ASCVD Risk (PREVENT Score)

PREVENT 10-Year ASCVD Risk *

ℹ️ ASCVD & VHR: If the patient has established ASCVD, check the specific events below in Section C (Prior MI, Stroke, PAD, etc.). The tool auto-detects Very High-Risk ASCVD from ≥2 major events, or 1 major event + ≥2 high-risk conditions (smoking, DM, HTN, CKD, FH, elevated LDL on max statin, HF, age ≥65). LDL goal <55 for VHR, <70 for ASCVD.

BLipid Panel

LDL-C mg/dL

HDL-C mg/dL

Total Chol mg/dL

Triglycerides mg/dL

Non-HDL-C auto-calculated

Apo B mg/dL

Lp(a) mg/dL

hs-CRP mg/L

⚠️ LDL-C ≥190 mg/dL — Possible Familial Hypercholesterolemia

Evaluate Dutch Lipid Clinic Network (DLCN) criteria. High-intensity statin is required regardless of PREVENT score. Consider genetic testing and cascade screening of first-degree relatives.

🔴 Triglycerides ≥500 mg/dL — Acute Pancreatitis Risk

Prioritize TG reduction. First-line: fenofibrate ± omega-3 FA. Withhold statin initiation until TG <500 mg/dL. Rule out secondary causes: hypothyroidism, poorly controlled DM, alcohol, medications.

CClinical ASCVD History (Secondary Prevention)

Prior MI / ACS

Acute coronary syndrome history

Revascularization

PCI, CABG, or carotid endarterectomy

Ischemic Stroke / TIA

Atherosclerotic cerebrovascular event

PAD

Peripheral arterial disease, ABI <0.9

Carotid Disease

Stenosis ≥50% or prior CEA/stent

Aortic Disease

Aneurysm or atherosclerotic aorta

Auto-syncs with Card 3 comorbidities (CAD, stroke, PAD, aorta) when entered.

DConfirm Risk Tier Auto-selected from PREVENT — override if needed

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Low Risk

PREVENT <3%

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Borderline

PREVENT 3–<5%

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Intermediate

PREVENT 5–<10%

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High Risk

PREVENT ≥10%

Risk-Enhancing Factors

Key for borderline & intermediate risk decisions — not in standard PREVENT

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💡 Why this section matters

Per 2026 ACC/AHA: In borderline (3–<5%) or intermediate (5–<10%) risk patients, the presence of risk-enhancing factors should tip the decision toward statin therapy. The PREVENT score does not incorporate all of these — this is where clinical judgment is applied.

Family Hx premature ASCVD1st-degree: <55M / <65F

Metabolic syndrome / ObesityAny 3 of 5 criteria, or BMI ≥30

Chronic inflammationRA, psoriasis, lupus, HIV

PCOSPolycystic ovary syndrome

Early menopauseBefore age 40

Preeclampsia

Gestational diabetesNew 2026 ACC/AHA

ABI <0.9Peripheral artery disease

South Asian ancestryHigher-risk ancestry

Filipino ancestryNew 2026 ACC/AHA

CKM syndromeCardiovascular-kidney-metabolic · New 2026

CKD (eGFR<60), TG≥175, LDL≥160, Lp(a)≥50 (Class 1), hs-CRP≥2, ApoB≥130 auto-detected from labs. New 2026 enhancers: Filipino ancestry, gestational DM, CKM syndrome.

Coronary Artery Calcium (CAC) Score

The key reclassifier — can tip statin decisions in either direction

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🔬 Clinical Role of CAC

ACC/AHA 2019: CAC = 0 supports withholding statins (unless DM, active smoking, or strong family history). CAC ≥100 or ≥75th percentile strongly supports statin initiation or intensification.

2026 ACC/AHA: CAC ≥300 or ≥75th MESA percentile for age/sex/race is a major risk-enhancing factor warranting high-intensity statin regardless of PREVENT risk tier.

CAC Score Obtained?

Not obtained

Yes — enter score

Ordered / Pending

CAC Score Agatston Units *

MESA Percentile age/sex/race-specific

🔗 Calculate percentile at mesa-nhlbi.org/mesa-cvd-tools

CAC Category — Auto-set from score or click to override

CAC = 0
Very low risk

1–99

Mild
Plaque present

100–299

Moderate
Statin benefit

≥300

Extensive
Aggressive Rx

💡 Consider Ordering CAC

For borderline (3–<5%) or intermediate (5–<10%) PREVENT risk patients where the statin decision is uncertain — especially if the patient has concerns about starting therapy — CAC scoring clarifies the decision. Low radiation (~1 mSv).

⏳ CAC Pending

Statin decision deferred pending CAC result. Document shared decision-making discussion in today's note.

Current Lipid-Lowering Therapy

Determines next-step recommendations

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ACurrent Statin

Statin

Dose mg

Intensity

Select statin…

BAdherence & Intolerance

Statin Adherence

Statin Intolerance

On Ezetimibe?

Tried alternate statin Tried lower dose Tried alternate-day dosing

COther Lipid-Lowering Agents

Ezetimibe↓LDL 15–20%

PCSK9 inhibitoralirocumab / evolocumab

Inclisiran (Leqvio)siRNA PCSK9 inhibitor

Bempedoic acidNexletol

Fibratefenofibrate / gemfibrozil

Icosapent Ethyl (Vascepa)2g BID — REDUCE-IT

Fibrate Type

Statin Intensity Reference

Intensity	LDL-C Reduction	Agents & Doses
HIGH	≥50%	Atorvastatin 40–80 mg • Rosuvastatin 20–40 mg
MODERATE	30–49%	Atorvastatin 10–20 mg • Rosuvastatin 5–10 mg • Pravastatin 40–80 mg • Simvastatin 20–40 mg
LOW	<30%	Simvastatin 10 mg • Pravastatin 10–20 mg • Fluvastatin 20–40 mg

Shared Decision-Making & Lifestyle

Documents the clinical discussion for your note

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Patient Preference

Diet Quality

Counseling Provided Today

Dietary counselingAHA diet — sat fat <7%

Exercise prescription≥150 min/wk aerobic

Smoking cessation offered

Weight management5–10% loss → ↓LDL 5–8

Considering pregnancyStatins are teratogenic — contraindicated

Additional Clinical Notes

📋 Clinical Summary

Clinical Recommendations

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Fill in your patient's data, then press Get Recommendations to generate a fully personalized clinical assessment.

All fields — BP, labs, comorbidities, current medications, and risk factors — are used to tailor the recommendation.

Quick start:
1. Enter SBP / DBP in Card 1
2. Add comorbidities, labs, and current meds
3. Press Get Recommendations ↓ at the bottom

Enter patient data above, then submit for recommendations

⚠ Data changed — resubmit

⚠️ Clinical Decision Support Tool — Not a substitute for clinical judgment. PreventCVD implements the 2025 AHA/ACC/Multisociety Hypertension Guideline (Jones DW, Ferdinand KC, Taler SJ, et al. Hypertension. 2025;82(10):e212-e316), JNC 8, and ADA 2024 Standards of Care. Incorporates PREVENT risk calculator guidance, updated primary aldosteronism screening, and pregnancy recommendations (CHAP trial). Recommendations must be individualized to the patient. Always verify drug dosing, interactions, contraindications, and allergy status. PreventCVD does not collect or transmit patient data.

📋 Auto-Generated Clinical Note — PreventCVD

Review and edit as needed. All data populated from the calculator. Copy and paste into your EHR note.