Impact of the 2017 American Heart Association and American College of Cardiology hypertension guideline in aged individuals
- 28 July 2020
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Hypertension
- Vol. 38 (12), 2527-2536
- https://doi.org/10.1097/hjh.0000000000002582
Abstract
Objectives: The AHA/ACC-2017 hypertension guideline recommends an age-independent target blood pressure (BP) of less than 130/80 mmHg. In an elderly cohort without established cardiovascular disease (CVD) at baseline, we determined the impact of this guideline on the prevalence of hypertension and associated CVD risk. Methods: Nineteen thousand, one hundred and fourteen participants aged at least 65 years from the ASPirin in Reducing Events in the Elderly (ASPREE) study were grouped by baseline BP: ‘pre-2017 hypertensive’ (BP ≥140/90 mmHg and/or on antihypertensive drugs); ‘reclassified hypertensive’ (normotensive by pre-2017 guidelines; hypertensive by AHA/ACC-2017 guideline), and ‘normotensive’ (BP versus 26%, P < 0.001) and lower CVD rates (8.9 versus 12.1/1000 person-years, P = 0.01) were observed in ‘reclassified hypertensive’ compared with ‘pre-2017 hypertensive’. Compared with ‘normotensive’, a hazard ratio (95% confidence interval) for CVD events of 1.60 (1.26–2.02) for ‘pre-2017 hypertensive’ and 1.26 (0.93–1.71) for ‘reclassified hypertensive’ was observed. Conclusion: Applying current CVD risk calculators in the elderly ‘reclassified hypertensive’, as a result of shifting the BP threshold lower, increases eligibility for antihypertensive treatment but documented CVD rates remain lower than hypertensive patients defined by pre2017 BP thresholds.This publication has 25 references indexed in Scilit:
- A Randomized Trial of Intensive versus Standard Blood-Pressure ControlThe New England Journal of Medicine, 2015
- 2013 ACC/AHA Guideline on the Assessment of Cardiovascular RiskCirculation, 2014
- 2014 Evidence-Based Guideline for the Management of High Blood Pressure in AdultsJAMA, 2014
- Medication Adherence in a Sample of Elderly Suffering from Hypertension: Evaluating the Influence of Illness Perceptions, Treatment Beliefs, and Illness BurdenJournal of Managed Care Pharmacy, 2014
- 2013 ACC/AHA Guideline on the Assessment of Cardiovascular RiskJournal of the American College of Cardiology, 2013
- Study design of ASPirin in Reducing Events in the Elderly (ASPREE): A randomized, controlled trialContemporary Clinical Trials, 2013
- 2013 ESH/ESC Guidelines for the management of arterial hypertensionJournal of Hypertension, 2013
- General Cardiovascular Risk Profile for Use in Primary CareCirculation, 2008
- Residual Lifetime Risk for Developing Hypertension in Middle-aged Women and MenJAMA, 2002
- Predominance of Isolated Systolic Hypertension Among Middle-Aged and Elderly US HypertensivesHypertension, 2001