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Population impact of different hypertension management guidelines based on the prospective population-based Heinz

Janine Gronewold1, Rene Kropp2, Nils Lehmann3

  • 1Department of Neurology, University Hospital Essen, Essen, Germany janine.gronewold@uk-essen.de.

BMJ Open
|February 18, 2021
PubMed

Insights

The ACC/AHA 2017 hypertension guideline recommends medication for more people, who then show higher cardiovascular event rates. Further trials are needed to confirm if this stricter guideline reduces cardiovascular disease.

Area of Science:

  • Cardiology
  • Public Health
  • Epidemiology

Background:

  • Hypertension guidelines vary significantly across different societies.
  • The ACC/AHA 2017 guideline recommends antihypertensive medication for a larger population segment compared to previous guidelines.
  • The comparative impact of different hypertension guidelines on cardiovascular risk has not been systematically evaluated.

Purpose of the Study:

  • To compare the prevalence of antihypertensive medication recommendations across major international hypertension guidelines.
  • To assess the association between guideline-based medication recommendations and incident cardiovascular events.

Main Methods:

  • The Heinz Nixdorf Recall study population (n=3092) without baseline medication was analyzed.
  • Prevalence of medication recommendation was compared using ACC/AHA 2017, JNC7, ESH/ESC 2013/2018, and WHO/ISH 2003/2020 guidelines.
  • Incident cardiovascular events were compared between participants with and without medication recommendations over a 5-year follow-up.

Main Results:

  • The ACC/AHA 2017 guideline identified the highest proportion of individuals (45.8%) for medication.
  • Compared to other guidelines, ACC/AHA 2017 recommended medication for significantly more participants.
  • Participants recommended for medication by ACC/AHA 2017 had a higher 5-year incidence of cardiovascular events (2.5% vs 1.1%, p=0.003).

Conclusions:

  • The ACC/AHA 2017 guideline identifies a higher-risk population for antihypertensive medication.
  • A higher incidence of cardiovascular events was observed in those recommended for medication under the ACC/AHA 2017 guideline.
  • Randomized controlled trials are warranted to determine if implementing the ACC/AHA 2017 guideline reduces cardiovascular disease.
Abstract

Keywords:
epidemiologyhypertensionpreventive medicinepublic healthvascular medicine

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