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

Michael Fernandes1, Marcel G M Olde Rikkert2

  • 1Medbase, Chapel Hill, NC, USA.

Contemporary Clinical Trials
|April 20, 2019
PubMed

Insights

The SPRINT trial informed new hypertension guidelines, lowering systolic blood pressure targets. A wait-and-see approach is advised due to uncertain clinical benefits and implementation challenges.

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.

Keywords:
ACC/AHA-2017 guidelineESH/ESC-2018 guidelineFallsHypertensionJNC-7/8LabelingMultimorbidityOvertreatmentPolypharmacySPRINT

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