Key result
Adults ≥60 years recommended antihypertensive treatment by ACC/AHA but not ACP/AAFP guidelines had high atherosclerotic cardiovascular disease event rates (18.0 to 18.2 per 1000 person-years).
Why the study?
Many adults aged 60 years or older are recommended to initiate or intensify antihypertensive medication by the 2017 ACC/AHA guideline but not the ACP/AAFP guideline.
Do adults ≥60 years old recommended for antihypertensive medication initiation or intensification by the ACC/AHA guideline but not the ACP/AAFP guideline have high atherosclerotic cardiovascular disease risk?
Cohort (n=11,592)
Yes
Do adults ≥60 years old recommended for antihypertensive medication initiation or intensification by the ACC/AHA guideline but not the ACP/AAFP guideline have high atherosclerotic cardiovascular disease risk?
Adults aged ≥60 years who are recommended for antihypertensive treatment initiation or intensification by the ACC/AHA guidelines but not the ACP/AAFP guidelines have a high risk of ASCVD events, supporting the more aggressive ACC/AHA targets.
Answers are grounded in this paper and cite their sources.
ACC/AHA recommends antihypertensive initiation or intensification for many adults ≥60 years not covered by ACP/AAFP; leaves open optimal thresholds for this population.
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.
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Jaeger et al. (2018) conducted a cohort in Hypertension (n=11,592). ACC/AHA guideline recommendation for antihypertensive treatment vs. ACP/AAFP guideline recommendation or neither guideline was evaluated on Atherosclerotic cardiovascular disease event rates per 1000 person-years. Adults ≥60 years recommended antihypertensive treatment by ACC/AHA but not ACP/AAFP guidelines had high atherosclerotic cardiovascular disease event rates (18.0 to 18.2 per 1000 person-years).
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