Adults with BP 130-139/80-89 mmHg recommended for treatment initiation by the 2017 ACC/AHA guideline had a higher CVD event rate than those not recommended (20.5 vs 3.4 per 1,000 person-years).
Cohort (n=29,218)
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Does recommendation for antihypertensive medication initiation or intensification by the 2017 ACC/AHA BP guideline identify adults at higher risk for cardiovascular disease events?
The 2017 ACC/AHA blood pressure guideline recommendations for initiating and intensifying antihypertensive therapy effectively target adults at high risk for cardiovascular events.
Tasa de eventos absoluta: 20.5% vs 3.4%
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. Objective: 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: We analyzed data for black and white REasons for Geographic And Racial Differences in Stroke (REGARDS) study participants (age ≥45 years). Systolic BP (SBP) and diastolic BP (DBP) were measured twice at baseline (2003–2007) 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 mmHg was 22.7 (95%CI 20.3–25.0). Among participants with SBP/DBP 130–139/80–89 mmHg, the CVD event rate was 20.5 (95%CI 18.5–22.6) and 3.4 (95%CI 2.4–4.4) 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 31.5–35.6) and 22.4 (95%CI 20.8–23.9) for those with SBP/DBP ≥140/90 mmHg and 130–139/80–89 mmHg, respectively. Conclusions: Implementing the 2017 ACC/AHA guideline would direct antihypertensive medication initiation and intensification to adults with high CVD risk.
“It specifically has as a goal that if [a patient has] greater than 10% 10-year cardiovascular risk, you should be more aggressive with treatment. That may sound obvious, but previous guidelines assumed that, never really defined it and never put it into context. This guideline does that, and it's a very important step forward.”
Colantonio et al. (Sat,) conducted a cohort in Cardiovascular disease risk (n=29,218). 2017 ACC/AHA guideline recommendation for antihypertensive medication initiation vs. Not recommended for antihypertensive medication initiation was evaluated on Cardiovascular disease (CVD) events (stroke, coronary heart disease and heart failure). Adults with BP 130-139/80-89 mmHg recommended for treatment initiation by the 2017 ACC/AHA guideline had a higher CVD event rate than those not recommended (20.5 vs 3.4 per 1,000 person-years).