Impact of the 2017 American Heart Association and American College of Cardiology hypertension guideline in aged individuals
Year: 2020
Type: article
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 <130 and <80 mmHg). For each group, we evaluated CVD risk factors, predicted 10-year CVD risk using the Atherosclerotic Cardiovascular Disease (ASCVD) risk equation, and reported observed CVD event rates during a median 4.7-year follow-up. RESULTS: Overall, 74.4% (14 213/19 114) were 'pre-2017 hypertensive'; an additional 12.3% (2354/19 114) were 'reclassified hypertensive' by the AHA/ACC-2017 guideline. Of those 'reclassified hypertensive', the majority (94.5%) met criteria for antihypertensive treatment although 29% had no other traditional CVD risk factors other than age. Further, a relatively lower mean 10-year predicted CVD risk (18% 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.
Source: Journal of Hypertension
Authors: Enayet Karim Chowdhury, Michael E. Ernst, Mark Nelson, Karen Margolis, Lawrie J. Beilin, Collin Johnston, Robyn Woods, Anne Murray, Rory Wolfe, Elsdon Storey, Raj C. Shah, Jessica Lockery, Andrew Tonkin, Anne Newman, Walter Abhayaratna, Nigel Stocks, Sharyn Fitzgerald, Suzanne Orchard, Ruth Trevaks, Geoffrey Donnan, R. Grimm, John McNeil, Christopher M. Reid
Institutions: Curtin University, Monash University, University of Iowa, University of Tasmania, Menzies Institute for Medical Research, HealthPartners, The University of Western Australia, Royal Perth Hospital, Baker Heart and Diabetes Institute, University of Minnesota, Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Rush University Medical Center, University of Pittsburgh, Australian National University, The University of Adelaide, The University of Melbourne, Florey Institute of Neuroscience and Mental Health
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: G1740950978, G313601605, ASPirin in Reducing Events in the Elderly - eXTension, ASPirin in Reducing Events in the Elderly, ASPREE Completion Project, G7210608478, Improving the Prevention, Treatment and Management of Cardiovascular & Chronic Disease in the Community, G8718603654, ASPirin in Reducing Events in the Elderly (ASPREE), Claude D. Pepper Older Americans Independence Center at the University of Michigan (UM Pepper Center)
OpenAlex ID: W3047040755