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2017 ACC/AHA Blood Pressure Treatment Guideline Recommendations and Cardiovascular Risk

Lisandro D Colantonio1, John N Booth1, Adam P Bress2

  • 1Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.

Journal of the American College of Cardiology
|September 8, 2018
PubMed

Insights

The 2017 ACC/AHA guideline helps identify adults needing blood pressure medication. Implementing this guideline directs treatment to those at high cardiovascular disease risk.

Area of Science:

  • Cardiology
  • Hypertension Management
  • Public Health

Background:

  • The 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline offers updated recommendations for initiating and intensifying antihypertensive medications.
  • Current clinical practice may not fully align with these updated guidelines, necessitating an evaluation of their impact on cardiovascular disease (CVD) risk.

Purpose of the Study:

  • To assess the risk of cardiovascular disease (CVD) events in adults recommended for, and not recommended for, antihypertensive medication initiation or intensification based on the 2017 ACC/AHA Blood Pressure (BP) guideline.
  • To evaluate the guideline's effectiveness in directing treatment to individuals with elevated CVD risk.

Main Methods:

  • Analysis of data from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study, including Black and White participants aged 45 years and older.
  • Categorization of participants based on their need for antihypertensive medication initiation or intensification according to the 2017 ACC/AHA BP guideline, comparing CVD event rates.
  • Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) were measured and averaged at baseline (2003-2007).

Main Results:

  • Among those not on medication, 34.4% were recommended treatment initiation. CVD event rates were higher for those recommended initiation (22.7 per 1,000 person-years for SBP/DBP ≥140/90 mmHg) compared to those not recommended.
  • For participants with SBP/DBP 130-139/80-89 mmHg not on medication, those recommended for initiation had a significantly higher CVD event rate (20.5) than those not recommended (3.4).
  • Among those on medication, 62.8% were recommended intensification. Higher CVD event rates were observed in those recommended for intensification (33.6 per 1,000 person-years for SBP/DBP ≥140/90 mmHg).

Conclusions:

  • The 2017 ACC/AHA guideline effectively identifies adults who would benefit from antihypertensive medication initiation and intensification.
  • Adherence to the guideline directs pharmacologic treatment towards individuals with higher cardiovascular disease risk, potentially improving outcomes.
Abstract

Keywords:
adultantihypertensive agentsblood pressurecardiovascular diseasehypertensionpractice guidelines

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