Abstract Background Preventing 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. Methods In 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. Results Over 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