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Impact of the 2017 American Heart Association and American College of Cardiology hypertension guideline in aged individuals

Citation

Chowdhury, EK and Ernst, ME and Nelson, M and Margolis, K and Beilin, LJ and Johnston, C and Woods, R and Murray, A and Wolfe, R and Storey, E and Shah, RC and Lockery, J and Tonkin, A and Newman, A and Abhayaratna, W and Stocks, N and Fitzgerald, S and Orchard, S and Trevaks, R and Donnan, G and Grimm, R and McNeil, J and Reid, CM, for the ASPREE Investigator Group, Impact of the 2017 American Heart Association and American College of Cardiology hypertension guideline in aged individuals, Journal of Hypertension, 38, (1) pp. 1-10. ISSN 0263-6352 (2020) [Refereed Article]

Copyright Statement

Copyright 2020 Wolters Kluwer Health, Inc.

DOI: doi: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 <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.

Item Details

Item Type:Refereed Article
Keywords:elderly, guidelines, hypertension, target blood pressure
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Cardiology (incl. cardiovascular diseases)
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Nelson, M (Professor Mark Nelson)
ID Code:140796
Year Published:2020
Deposited By:Menzies Institute for Medical Research
Deposited On:2020-09-08
Last Modified:2020-10-16
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