Impact of the 2017 American Heart Association and American College of Cardiology hypertension guideline in aged individuals

Enayet Karim Chowdhury, Michael E. Ernst, Mark Nelson, Karen Margolis, Lawrie J. Beilin, Collin Johnston, Robyn Woods, Anne Murray, Rory Wolfe, Elsdon Storey, Raj C. Shah, Jessica Lockery, Andrew Tonkin, Anne Newman, Walter Abhayaratna, Nigel Stocks, Sharyn Fitzgerald, Suzanne Orchard, Ruth Trevaks, Geoffrey DonnanR. Grimm, John McNeil, Christopher M. Reid, for the ASPREE Investigator Group

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objectives: The AHA/ACC-2017 hypertension guideline recommends an age-independent target blood pressure (BP) of less than 130/80 mmHg. In an elderly cohort without established cardiovascular disease (CVD) at baseline, we determined the impact of this guideline on the prevalence of hypertension and associated CVD risk. Methods: Nineteen thousand, one hundred and fourteen participants aged at least 65 years from the ASPirin in Reducing Events in the Elderly (ASPREE) study were grouped by baseline BP: 'pre-2017 hypertensive' (BP <140/90mmHg and/or on antihypertensive drugs); 'reclassified hypertensive' (normotensive by pre-2017 guidelines; hypertensive by AHA/ACC-2017 guideline), and 'normotensive' (BP <130 and <80 mmHg). For each group, we evaluated CVD risk factors, predicted 10-year CVD risk using the Atherosclerotic Cardiovascular Disease (ASCVD) risk equation, and reported observed CVD event rates during a median 4.7-year follow-up. Results: Overall, 74.4% (14 213/19 114) were 'pre-2017 hypertensive'; an additional 12.3% (2354/19 114) were 'reclassified hypertensive' by the AHA/ACC-2017 guideline. Of those 'reclassified hypertensive', the majority (94.5%) met criteria for antihypertensive treatment although 29% had no other traditional CVD risk factors other than age. Further, a relatively lower mean 10-year predicted CVD risk (18% versus 26%, P<0.001) and lower CVD rates (8.9 versus 12.1/1000 person-years, P=0.01) were observed in 'reclassified hypertensive' compared with 'pre-2017 hypertensive'. Compared with 'normotensive', a hazard ratio (95% confidence interval) for CVD events of 1.60 (1.26-2.02) for 'pre-2017 hypertensive' and 1.26 (0.93-1.71) for 'reclassified hypertensive' was observed. Conclusion: Applying current CVD risk calculators in the elderly 'reclassified hypertensive', as a result of shifting the BP threshold lower, increases eligibility for antihypertensive treatment but documented CVD rates remain lower than hypertensive patients defined by pre2017 BP thresholds.

Original languageEnglish
Pages (from-to)2527-2536
Number of pages10
JournalJournal of Hypertension
Volume38
Issue number12
DOIs
Publication statusPublished - Dec 2020

Keywords

  • Elderly
  • Guidelines
  • Hypertension
  • Target blood pressure

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