In a recent study, researchers predict that achieving and maintaining the 2017 guideline blood pressure goals could prevent more than 3 million cardiovascular disease events over ten years.
In 2017, the American College of Cardiology and the American Heart Association released new blood pressure guidelines, lowering hypertension threshold to 130/80 mm Hg from the previous 140/90 mm Hg.
Treating high blood pressure is a major public health opportunity to protect health and quality of life for tens of millions of Americans. Achieving these lower goals will be challenging.
The team wanted to explore the impact of achieving and maintaining the lower guideline-recommendations on the public compared to earlier blood pressure and treatment levels, as well as patients’ ability to achieve and maintain earlier guideline recommendations.
They predicted the number of cardiovascular events averted in middle-age adults based on the blood pressure goals of the 2017 blood pressure guidelines (< 130/80 mm Hg), the seventh Joint National Committee (JNC7) guidelines (< 140/90 mm Hg) and the eighth Joint National Committee (JNC8) guidelines (140/90 mg Hg for patients younger than 60 and 150/90 mm Hg for patients older than 60).
Their analysis projects 3.3 million fewer cardiovascular disease events after achieving and maintaining the 2017 blood pressure goals compared to current blood pressure levels.
The researcher also found that achieving and maintaining the JNC7 and JNC8 recommended blood pressure goals would prevent 2.6 and 1.6 million cardiovascular disease events, respectively.
This study made these predictions using several contemporary, population-based databases.
The NHANES dataset is a national representative survey of the U.S. adult population and provides population sizes of hypertension treatment groups by blood pressure levels and chronic conditions.
The REGARDS database provides a source for the risk of fatal and nonfatal cardiovascular events.
A recent meta-analysis of 42 randomized blood pressure-lowering clinical trials, consisting of more than 140,000 participants, provides the risk reduction predictions for cardiovascular events based on achieving and maintaining different blood pressure treatment targets.
The majority of cardiovascular disease events prevented came from those with current blood pressure levels above 140/90 mm Hg.
Models assumed that patients achieved and maintained blood pressure goals over the course of the simulation.
Previous studies have suggested the initial upfront investment for treating more adults for hypertension leads to health gains and cost savings over the lifetime of treatment. But change does not always come easily.
Treating more patients to achieve lower blood pressure goals does have risks. The team notes that medications often come with side effects, which need to be monitored and managed.
The results are based on a database that is not representative of the diversity in the country, including information for only white and black patients that are at least 45 years old.
It also does not directly account for future changes in blood pressure or changes in antihypertensive medications through time.
The team suggests a conversation and shared decision making between provider and patient about benefits and risks of increasing the dose of a medication or adding a new medication to achieve a lower target are important.
The study’s lead author is Adam Bress, Pharm.D., M.S. at University of Utah Health. Andrew Moran at the Columbia University, is the senior author on the paper.
The results of the study is published in Circulation.
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