20 Nov Millions of Cardiovascular Events Preventable If New Lower Blood Pressure Guidelines Adopted
MedicalResearch.com Interview with:
Dr. Bress
Adam Bress, Pharm.D
Department of Population Health Sciences
School of Medicine
University of Utah
MedicalResearch.com: What is the background for this study? What are the main findings?
o The background here is that the new 2017 ACC/AHA BP guidelines lowered the threshold for antihypertensive medication initiation and intensification from <140 mmHg in most patients to <130 mm Hg.
o We used contemporary, population-based studies of US adults to estimate the potential population health impact of achieving and maintaining the lower treatment targets recommended in the 2017 ACC/AHA BP guidelines compared to previous guidelines.
o We found that achieving and maintain the lower thresholds recommended in the 2017 ACC/AHA BP guidelines over 10 years would:
- Prevent 3.0 million CVD events compared to currently blood pressure and treatment levels
- Prevent 0.5 million more events compared to achieving and maintain JNC7 goals
- Prevent 1.4 million more events compared to achieving and maintain JNC7 goals
o We estimated the size of the population health impact of achieving and maintaining the lower blood pressure treatment targets in the 2017 ACC/AHA BP guidelines compared to previous guidelines.
- Achieving and maintaining the lower blood pressure thresholds for antihypertensive medication initiation and titration by the 2017 guidelines, are projected to prevent ~20% and ~90% more CVD events over ten years compared to achieving and maintaining JNC7 or JNC8 goals respectively.
o Although we estimated more adverse events with the lower treatment goal, what our analysis found is that the benefits of achieving and maintaining the 2017 high blood pressure treatment recommendations far outweighs the risks. Many adverse events from high blood pressure treatment can be managed medically – and the lower threshold for treatment could potentially help millions of Americans lower their chances of developing heart disease or dying from heart attacks, strokes and other cardiovascular events,
MedicalResearch.com: What should readers take away from your report?
Response: The take-home message is that we know we have safe, effective, and inexpensive antihypertensive medications as well as proven implementation strategies such as team-based care to more effectively control blood pressure pressure. Our analysis sets the bounds for what is possible if we can focus on and invest in blood pressure measurement, treatment, and implementation strategies at the population level.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
o Safe, effective, and inexpensive antihypertensive medications have been available for decades. More recently, over 40 randomized trials show that team-based care with a pharmacist achieved the greatest BP control rates compared to other implementation strategies and team-based care (Ann Intern Med. 2018;168(2):110-120) .
o Therefore, investing resources in the measurement, treatment, and control of hypertension is a public best buy and should be prioritized by governments, payers, and population health managers.
Any disclosures?
I receive funds to my institution from the NIH and Novartis, Amgen, and Amarin unrelated to the current project.
Citation:
Adam P. Bress ,Lisandro D Colantonio ,Richard Cooper
Holly Kramer,John N. Booth III ,Michelle C. Odden
,Kirsten Bibbins-Domingo ,Daichi Shimbo
Paul K. Whelton, Emily B. Levitan et al
Originally published19 Nov 201 8 Circulation. 2018;0
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Last Updated on November 20, 2018 by Marie Benz MD FAAD