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BP classification using the 2017 ACC/AHA BP guidelines with risk of cardiovascular events in older individuals
Yuta Suzuki1, Hidehiro Kaneko2, Akira Okada3
1The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan; Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Saitama, Japan.
Insights
Stage 1 hypertension increases cardiovascular disease risk in adults over 60. Lowering systolic blood pressure may reduce stroke risk, but further research is needed for those over 75.
Area of Science:
- Cardiology
- Geriatrics
- Public Health
Background:
- The link between stage 1 hypertension and cardiovascular disease (CVD) risk in older adults is unclear.
- The benefit of blood pressure (BP) reduction for stage 1 hypertension in this demographic is unknown.
Purpose of the Study:
- To investigate the association between stage 1 hypertension and CVD risk in individuals aged 60 years and older.
- To explore the impact of BP lowering on CVD events in this population.
Main Methods:
- A cohort study utilized nationwide Japanese data from the DeSC database (n=476,654).
- Participants were categorized based on 2017 ACC/AHA BP guidelines.
- Primary outcome was a composite CVD event (myocardial infarction, angina, stroke, heart failure) over a mean 3.1-year follow-up.
Main Results:
- Stage 1 hypertension was associated with a 10% increased risk of composite CVD events (HR 1.10).
- Specific risks included myocardial infarction (HR 1.16), angina (HR 1.06), stroke (HR 1.13), and heart failure (HR 1.13).
- A ≥5 mmHg systolic BP decrease correlated with reduced stroke risk; this association was weaker in those ≥75 years.
Conclusions:
- Stage 1 hypertension poses a significant CVD risk in older adults.
- Current ACC/AHA BP guidelines may apply to older populations, but require further validation for individuals ≥75 years.
Background:
The association between stage 1 hypertension and the risk of cardiovascular disease (CVD) has not been established in older adults. Furthermore, little is known about whether lowering blood pressure (BP) is beneficial in older adults with stage 1 hypertension.
Methods:
This cohort study analyzed nationwide data collected from the Japanese DeSC database, including 476,654 individuals aged ≥60 years. Individuals were categorized into four groups according to the 2017 ACC/AHA BP guidelines: normal BP, elevated BP, stage 1 hypertension, and stage 2 hypertension. The primary outcome was a composite CVD event, including myocardial infarction, angina pectoris, stroke, and heart failure.
Results:
During a mean follow-up of 3.1 years, 53,946 composite CVD events were recorded. Hazard ratios of stage 1 hypertension for composite CVD events, myocardial infarction, angina pectoris, stroke, and heart failure were 1.10 (95 % CI, 1.07-1.13), 1.16 (95 % CI, 1.03-1.31), 1.06 (95 % CI, 1.01-1.10), 1.13 (95 % CI, 1.08-1.18), and 1.13 (95 % CI, 1.09-1.16), respectively. Individuals with a ≥5 mmHg decrease in systolic BP over one year had a lower risk of stroke among individuals with stage 1 hypertension. The positive association between stage 1 hypertension and composite CVD events was attenuated in individuals aged ≥75 years.
Conclusions:
Stage 1 hypertension is associated with a higher risk of developing CVD events among older adults. The 2017 ACC/AHA BP guidelines could be applied to older populations; however, the applicability of these guidelines to older adults aged ≥75 years requires further investigations.
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