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J Am Coll Cardiol. 2018 Sep 11;72(11):1187-1197. doi: 10.1016/j.jacc.2018.05.074.

2017 ACC/AHA Blood Pressure Treatment Guideline Recommendations and Cardiovascular Risk.

Author information

1
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama. Electronic address: lcolantonio@uab.edu.
2
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
3
Department of Population Health Sciences, University of Utah, Salt Lake City, Utah.
4
Department of Epidemiology, Tulane University, New Orleans, Louisiana.
5
Department of Medicine, Columbia University, New York, New York.
6
Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama.
7
Department of Medicine, Weill Cornell Medical College, New York, New York.

Abstract

BACKGROUND:

The 2017 American College of Cardiology/American Heart Association (ACC/AHA) blood pressure (BP) guideline provides updated recommendations for antihypertensive medication initiation and intensification.

OBJECTIVES:

Determine the risk for cardiovascular disease (CVD) events among adults recommended and not recommended antihypertensive medication initiation or intensification by the 2017 ACC/AHA BP guideline.

METHODS:

The authors analyzed data for black and white REGARDS (REasons for Geographic And Racial Differences in Stroke) study participants (age ≥45 years). Systolic BP (SBP) and diastolic BP (DBP) were measured twice at baseline (2003 to 2007) and averaged. Participants not taking (n = 14,039) and taking (n = 15,179) antihypertensive medication were categorized according to their recommendations for antihypertensive medication initiation and intensification by the 2017 ACC/AHA guideline. Overall, 4,094 CVD events (stroke, coronary heart disease, and heart failure) occurred by December 31, 2014.

RESULTS:

Among participants not taking antihypertensive medication, 34.4% were recommended pharmacological antihypertensive treatment initiation. The CVD event rate per 1,000 person-years among participants recommended antihypertensive medication initiation with SBP/DBP ≥140/90 mm Hg was 22.7 (95% confidence interval [CI]: 20.3 to 25.0). Among participants with SBP/DBP 130 to 139/80 to 89 mm Hg, the CVD event rate was 20.5 (95% CI: 18.5 to 22.6) and 3.4 (95% CI: 2.4 to 4.4) for those recommended and not recommended antihypertensive medication initiation, respectively. Among participants taking antihypertensive medication, 62.8% were recommended treatment intensification. The CVD event rate per 1,000 person-years among participants recommended treatment intensification was 33.6 (95% CI: 31.5 to 35.6) and 22.4 (95% CI: 20.8 to 23.9) for those with SBP/DBP ≥140/90 mm Hg and 130 to 139/80 to 89 mm Hg, respectively.

CONCLUSIONS:

Implementing the 2017 ACC/AHA guideline would direct antihypertensive medication initiation and intensification to adults with high CVD risk.

KEYWORDS:

adult; antihypertensive agents; blood pressure; cardiovascular disease; hypertension; practice guidelines

PMID:
30189994
DOI:
10.1016/j.jacc.2018.05.074

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