Lisandro D Colantonio1, John N Booth2, Adam P Bress3, Paul K Whelton4, Daichi Shimbo5, Emily B Levitan2, George Howard6, Monika M Safford7, Paul Muntner2. 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.
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.
Authors: Robert H Eckel; John M Jakicic; Jamy D Ard; Janet M de Jesus; Nancy Houston Miller; Van S Hubbard; I-Min Lee; Alice H Lichtenstein; Catherine M Loria; Barbara E Millen; Cathy A Nonas; Frank M Sacks; Sidney C Smith; Laura P Svetkey; Thomas A Wadden; Susan Z Yanovski Journal: J Am Coll Cardiol Date: 2013-11-12 Impact factor: 24.094
Authors: Paul Muntner; Robert M Carey; Samuel Gidding; Daniel W Jones; Sandra J Taler; Jackson T Wright; Paul K Whelton Journal: J Am Coll Cardiol Date: 2017-11-13 Impact factor: 24.094
Authors: Lawrence J Appel; Catherine M Champagne; David W Harsha; Lawton S Cooper; Eva Obarzanek; Patricia J Elmer; Victor J Stevens; William M Vollmer; Pao-Hwa Lin; Laura P Svetkey; Sarah W Stedman; Deborah R Young Journal: JAMA Date: 2003 Apr 23-30 Impact factor: 56.272
Authors: P K Whelton; L J Appel; M A Espeland; W B Applegate; W H Ettinger; J B Kostis; S Kumanyika; C R Lacy; K C Johnson; S Folmar; J A Cutler Journal: JAMA Date: 1998-03-18 Impact factor: 56.272
Authors: Joshua D Bundy; Changwei Li; Patrick Stuchlik; Xiaoqing Bu; Tanika N Kelly; Katherine T Mills; Hua He; Jing Chen; Paul K Whelton; Jiang He Journal: JAMA Cardiol Date: 2017-07-01 Impact factor: 14.676
Authors: Adam P Bress; Lisandro D Colantonio; Richard S Cooper; Holly Kramer; John N Booth; Michelle C Odden; Kirsten Bibbins-Domingo; Daichi Shimbo; Paul K Whelton; Emily B Levitan; George Howard; Brandon K Bellows; Dawn Kleindorfer; Monika M Safford; Paul Muntner; Andrew E Moran Journal: Circulation Date: 2019-01-02 Impact factor: 29.690
Authors: Donald E Casey; Randal J Thomas; Vivek Bhalla; Yvonne Commodore-Mensah; Paul A Heidenreich; Dhaval Kolte; Paul Muntner; Sidney C Smith; John A Spertus; John R Windle; Gregory D Wozniak; Boback Ziaeian Journal: J Am Coll Cardiol Date: 2019-11-26 Impact factor: 24.094
Authors: Donald E Casey; Randal J Thomas; Vivek Bhalla; Yvonne Commodore-Mensah; Paul A Heidenreich; Dhaval Kolte; Paul Muntner; Sidney C Smith; John A Spertus; John R Windle; Gregory D Wozniak; Boback Ziaeian Journal: Circ Cardiovasc Qual Outcomes Date: 2019-11-12