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Hypertension. 2019 Feb;73(2):327-334. doi: 10.1161/HYPERTENSIONAHA.118.12291.

Cardiovascular Disease and Mortality in Adults Aged ≥60 Years According to Recommendations by the American College of Cardiology/American Heart Association and American College of Physicians/American Academy of Family Physicians.

Author information

1
From the Department of Biostatistics (B.C.J., G.H., D.L.L.), University of Alabama at Birmingham.
2
Department of Medicine, Columbia University, New York City, NY (D.E.A., D.S.).
3
Department of Population Health Sciences, University of Utah, Salt Lake City (A.P.B.).
4
Department of Epidemiology (J.N.B., P.M.), University of Alabama at Birmingham.
5
Department of Population Health Sciences, New York University School of Medicine, NY (M.B., J.K., G.O.).
6
Department of Medicine, University of Mississippi, Jackson (D.C., M.S.).
7
Department of Medicine, University of Vermont, Burlington (T.B.P.).
8
Geriatrics Division, Department of Internal Medicine, University of Utah School of Medicine, and George E. Wahlen Veterans Affairs Medical Center, Geriatric Research, Education and Clinical Center, Salt Lake City (M.A.S.).
9
Department of Epidemiology, Tulane University, New Orleans, LA (P.K.W.).

Abstract

In 2017, the American College of Cardiology/American Heart Association (ACC/AHA) and the American College of Physicians/American Academy of Family Physicians (ACP/AAFP) published blood pressure guidelines. Adults recommended antihypertensive medication initiation or intensification by the ACP/AAFP guideline receive the same recommendation from the ACC/AHA guideline. However, many adults ≥60 years old are recommended to initiate or intensify antihypertensive medication by the ACC/AHA but not the ACP/AAFP guideline. We compared atherosclerotic cardiovascular disease event rates according to antihypertensive treatment recommendations in the ACC/AHA and ACP/AAFP guidelines among adults ≥60 years old with systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥80 mm Hg in the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) and the JHS (Jackson Heart Study). Among 4311 participants not taking antihypertensive medication at baseline, 11.4%, 61.2%, and 27.4% were recommended antihypertensive medication initiation by neither guideline, the ACC/AHA but not the ACP/AAFP guideline, and both guidelines, respectively. Atherosclerotic cardiovascular disease event rates (95% CI) for these groups were 3.4 (1.6-5.2), 18.0 (16.1-19.8), and 25.3 (21.9-28.6) per 1000 person-years, respectively. Among 7281 participants taking antihypertensive medication at baseline, 57.9% and 42.1% were recommended antihypertensive medication intensification by the ACC/AHA but not the ACP/AAFP guideline and both guidelines, respectively. Atherosclerotic cardiovascular disease event rates (95% CI) for these groups were 18.2 (16.7-19.7) and 33.0 (30.5-35.4) per 1000 person-years, respectively. In conclusion, adults recommended initiation or intensification of antihypertensive medication by the ACC/AHA but not the ACP/AAFP guideline have high atherosclerotic cardiovascular disease risk that may be reduced through treatment initiation or intensification.

KEYWORDS:

adults; blood pressure; coronary heart disease; hypertension; stroke

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