The new US and European guidelines in hypertension: A multi-dimensional analysis

Area of Science:

• Cardiology
• Clinical Trials
• Public Health

Background:

• The Systolic Blood Pressure Intervention Trial (SPRINT) established clinical outcomes for systolic blood pressure (SBP) targets of 140 vs. 120 mmHg.
• Current hypertension guidelines (2017 ACC/AHA, 2018 ESC/ESH) are based on SPRINT, recommending lower treatment thresholds than previous guidelines like JNC-8.
• JNC-8 advised treatment initiation at 140/90 mmHg, with a 150/90 mmHg target for adults over 60.

Purpose of the Study:

• To qualitatively analyze the potential benefits, simplicity, safety, and affordability of implementing new hypertension guidelines.
• To determine if the new guidelines, informed by the SPRINT trial, will achieve their intended clinical benefits.
• To assess the feasibility of translating these lower blood pressure targets into clinical practice.

Main Methods:

• Qualitative multi-dimensional analysis of the SPRINT trial's impact on hypertension guidelines.
• Comparison of new guideline targets with previous recommendations (JNC-8).
• Evaluation of the implications for healthcare systems regarding investment and clinical practice.

Main Results:

• New guidelines recommend lower SBP targets: 10 mmHg reduction for <60 years and 20 mmHg for ≥60 years compared to JNC-8.
• Significant national healthcare investment is required for guideline implementation.
• A definitive answer on clinical benefit and implementation feasibility is currently unavailable.

Conclusions:

• A 'wait and see' approach is deemed appropriate regarding the adoption of new, lower hypertension treatment targets.
• Focus should remain on addressing the global issue of untreated hypertension.
• Further evaluation is needed to justify the clinical benefits and resource allocation for the new guidelines.