TY - JOUR
T1 - Impact of the 2017 American Heart Association and American College of Cardiology hypertension guideline in aged individuals
AU - Chowdhury, Enayet Karim
AU - Ernst, Michael E.
AU - Nelson, Mark
AU - Margolis, Karen
AU - Beilin, Lawrie J.
AU - Johnston, Collin
AU - Woods, Robyn
AU - Murray, Anne
AU - Wolfe, Rory
AU - Storey, Elsdon
AU - Shah, Raj C.
AU - Lockery, Jessica
AU - Tonkin, Andrew
AU - Newman, Anne
AU - Abhayaratna, Walter
AU - Stocks, Nigel
AU - Fitzgerald, Sharyn
AU - Orchard, Suzanne
AU - Trevaks, Ruth
AU - Donnan, Geoffrey
AU - Grimm, R.
AU - McNeil, John
AU - Reid, Christopher M.
AU - for the ASPREE Investigator Group
N1 - Funding Information:
Funding: The work was supported by the National Institute on Aging and the National Cancer Institute at the National Institutes of Health (grant number U01AG029824); the National Health and Medical Research Council of Australia (grant numbers 334047, 1127060); Monash University (Australia); and the Victorian Cancer Agency (Australia).
Funding Information:
Bayer AG supplied study drug (aspirin) and matching placebo also produce BP lowering medication (no link with ASPREE’s participants) and had no other role in the trial. E.K.C. has received High Blood Pressure Research Council Australia early career research transition grant to support current work. M.R.N. received travel and consultancy support from Bayer to attend a meeting in Berlin. A.M.T. has received unrelated research support and honoraria/travel expenses from Bayer. C.M.R. is supported on a NHMRC Principal Research Fellowship (1136372). All other authors have no conflict of interest to declare in relation to this study.
Publisher Copyright:
© 2020 Wolters Kluwer Health, Inc. All rights reserved.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2020/12
Y1 - 2020/12
N2 - 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.
AB - 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.
KW - Elderly
KW - Guidelines
KW - Hypertension
KW - Target blood pressure
UR - http://www.scopus.com/inward/record.url?scp=85095799755&partnerID=8YFLogxK
U2 - 10.1097/HJH.0000000000002582
DO - 10.1097/HJH.0000000000002582
M3 - Article
C2 - 32740404
AN - SCOPUS:85095799755
VL - 38
SP - 2527
EP - 2536
JO - Journal of Hypertension
JF - Journal of Hypertension
SN - 0263-6352
IS - 12
ER -
