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

Chowdhury, EK, Ernst, ME, Nelson, M ORCID: 0000-0001-9941-7161, Margolis, K, Beilin, LJ, Johnston, C, Woods, R, Murray, A, Wolfe, R, Storey, E, Shah, RC, Lockery, J, Tonkin, A, Newman, A, Abhayaratna, W, Stocks, N, Fitzgerald, S, Orchard, S, Trevaks, R, Donnan, G, Grimm, R, McNeil, J and Reid, CM 2020 , 'Impact of the 2017 American Heart Association and American College of Cardiology hypertension guideline in aged individuals' , Journal of Hypertension, vol. 38, no. 1 , pp. 1-10 , doi: 10.1097/HJH.0000000000002582.

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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 ≥140/90 mmHg and/or on antihypertensive drugs); 'reclassified hypertensive' (normotensive by pre-2017 guidelines; hypertensive by AHA/ACC-2017 guideline), and 'normotensive' (BP 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 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.

Item Type: Article
Authors/Creators:Chowdhury, EK and Ernst, ME and Nelson, M and Margolis, K and Beilin, LJ and Johnston, C and Woods, R and Murray, A and Wolfe, R and Storey, E and Shah, RC and Lockery, J and Tonkin, A and Newman, A and Abhayaratna, W and Stocks, N and Fitzgerald, S and Orchard, S and Trevaks, R and Donnan, G and Grimm, R and McNeil, J and Reid, CM
Keywords: elderly, guidelines, hypertension, target blood pressure
Journal or Publication Title: Journal of Hypertension
Publisher: Lippincott Williams & Wilkins
ISSN: 0263-6352
DOI / ID Number: 10.1097/HJH.0000000000002582
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Copyright © 2020 Wolters Kluwer Health, Inc.

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