Baseline Blood Pressure, the 2017 ACC/AHA High Blood Pressure Guidelines, and Long-Term Cardiovascular Risk in SPRINT
- Authors:
- DOI:
- 10.1016/j.amjmed.2017.12.049
- Abstract:
- BACKGROUND: The 2017 ACC/AHA guidelines include lower thresholds to define hypertension than previous guidelines. Little is known about the impact of these guideline changes in patients with or at high risk for cardiovascular disease. METHODS: In this exploratory analysis using baseline blood pressure assessments in SPRINT (Systolic Blood Pressure Intervention Trial), we evaluated the prevalence and associated cardiovascular prognosis of patients newly reclassified with hypertension based on the 2017 ACC/AHA (SBP≥130mmHg or DBP≥80mmHg) compared with the JNC 7 guidelines (SBP≥140mmHg or DBP≥90mmHg). The primary endpoint was the composite of myocardial infarction, other acute coronary syndromes, stroke, heart failure, or cardiovascular death. RESULTS: In 4,683 patients assigned to the standard treatment arm of SPRINT, 2,328 (49.7%) met hypertension thresholds by JNC 7 guidelines, and another 1,424 (30.4%) were newly reclassified as having hypertension based on the 2017 ACC/AHA guidelines. Over 3.3-year median follow-up, 319 patients experienced the primary endpoint (87 of whom were newly reclassified with hypertension based on the revised guidelines). Patients with hypertension based on prior guidelines compared with those newly identified with hypertension based on the new guidelines had similar risk of the primary endpoint [2.3 (2.0-2.7) vs. 2.0 (1.6-2.4) events per 100 patient-years; adjusted HR, 1.10 (95% CI, 0.84-1.44); P=0.48]. CONCLUSIONS: The 2017 ACC/AHA high blood pressure guidelines are expected to significantly increase the prevalence of patients with hypertension (perhaps to a greater extent in higher-risk patient cohorts compared with the general population) and identify greater numbers of patients who will ultimately experience adverse cardiovascular events. TRIAL REGISTRATION: SPRINT (Systolic Blood Pressure Intervention Trial); ClinicalTrials.gov Identifier: NCT01206062, https://clinicaltrials.gov/ct2/show/NCT01206062.
- Type:
- Journal article
- Language:
- English
- Published in:
- American Journal of Medicine, 2018, Vol 131, Issue 8
- Keywords:
- Journal Article
- Main Research Area:
- Medical science
- Publication Status:
- Published
- Review type:
- Peer Review
- Submission year:
- 2018
- Scientific Level:
- Scientific
- ID:
- 2396129510
