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Prevalence of Hypertension and Cardiovascular Risk According to Blood Pressure Thresholds Used for Diagnosis.

ABSTRACT: We sought to estimate the prevalence of hypertension and characteristics of hypertensive adults in the United States according to blood pressure (BP) thresholds used for diagnosis and estimate their associated cardiovascular disease risk. Analyses included adults 20 years of age or older in the 2013 to 2014 National Health and Nutrition Examination Survey (N=5389) and enrolled participants in SPRINT (Systolic Blood Pressure Intervention Trial; N=9361) and the ACCORD-BP trial (Action to Control Cardiovascular Risk in Diabetes-Blood Pressure; N=4733). In the National Health and Nutrition Examination Survey, prevalence estimates incorporated the probability of observing elevated BP on 2 separate occasions. Using the new BP thresholds of ?130/80 mm?Hg, ?24 million new American adults would be diagnosed as having hypertension and 4.3 million would be recommended to start antihypertensive medications. These individuals would have a lower mean atherosclerotic cardiovascular disease risk (17%) than participants in SPRINT and ACCORD-BP (22% and 27%) and would be less likely to have prevalent cardiovascular disease (9% versus 17% and 34%). In SPRINT and ACCORD-BP, only a minority (9% and 13%) of participants were not on antihypertensive medications at baseline, and rates of incident cardiovascular disease in these participants were substantially lower compared with those on baseline BP medications. We conclude that adopting the American College of Cardiology/American Heart Association guidelines would lead to a substantial increase in the prevalence of hypertension and in the number of American adults recommended to start antihypertensive medications. These individuals would have a substantially lower cardiovascular risk than most participants previously studied in 2 large BP trials.

SUBMITTER: Lamprea-Montealegre JA

PROVIDER: S-EPMC6205214 | biostudies-literature | 2018 Sep

REPOSITORIES: biostudies-literature

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Prevalence of Hypertension and Cardiovascular Risk According to Blood Pressure Thresholds Used for Diagnosis.

Lamprea-Montealegre Julio A JA Zelnick Leila R LR Hall Yoshio N YN Bansal Nisha N de Boer Ian H IH

Hypertension (Dallas, Tex. : 1979) 20180901 3

We sought to estimate the prevalence of hypertension and characteristics of hypertensive adults in the United States according to blood pressure (BP) thresholds used for diagnosis and estimate their associated cardiovascular disease risk. Analyses included adults 20 years of age or older in the 2013 to 2014 National Health and Nutrition Examination Survey (N=5389) and enrolled participants in SPRINT (Systolic Blood Pressure Intervention Trial; N=9361) and the ACCORD-BP trial (Action to Control C ...[more]

PMID: 30354757

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Project description:BackgroundFor five decades, blood pressure lowering treatment has been recommended for patients with hypertension (currently defined as blood pressure of ≥140/90 mm Hg). In the past 20 years, guidelines for treatment began incorporating predicted absolute cardiovascular disease risk (predicted risk) and reducing blood pressure thresholds. The blood pressure threshold at which to start treatment has become a secondary consideration in some countries. We aimed to provide descriptive data to assess the relative importance of blood pressure thresholds versus predicted risk on the subsequent rate of cardiovascular disease to inform treatment decisions.MethodsIn this English population-based cohort study, we used linked data from the Clinical Practice Research Datalink (CPRD) GOLD, Hospital Episode Statistics Admitted Patient Care, and the Office for National Statistics mortality data, and area-based deprivation indices (Townsend scores). Eligible patients were aged 30-79 years on Jan 1, 2011 (cohort entry date) and could be linked to hospital, mortality, and deprivation data. Patients were followed up until death, end of CPRD follow-up, or Nov 31, 2018. We examined three outcomes: cardiovascular disease, markers of potential target organ damage, and incident dementia without a known cause. The rate of each outcome was estimated and stratified by systolic blood pressure and predicted 10-year risk of cardiovascular disease (QRISK2 algorithm).FindingsBetween Jan 1, 2011, and Nov 31, 2018, 1 098 991 patients were included in the cohort and followed up for a median of 4·3 years (IQR 2·6-6·0; total follow-up of 4·6 million person-years). Median age at entry was 52 years (IQR 42-62) and 629 711 (57·3%) patients were female. There were 51 996 cardiovascular disease events and the overall rate of cardiovascular disease was 11·2 per 1000 person-years (95% CI 11·1-11·3). Median QRISK2 10-year predicted risk was 4·6% (IQR 1·4-12·0) and mean systolic blood pressure before cohort entry was 129·1 mm Hg (SD 15·7). Within strata of predicted risk, the effect of increasing systolic blood pressure on outcomes was small. For example, in the group with 10·0-19·9% predicted risk, rates of all cardiovascular disease rose from 20·1 to 23·6 per 1000 person-years between systolic blood pressures less than 110 mm Hg and 180 and higher mm Hg. But among patients with systolic blood pressure 140·0-149·9 mm Hg, rates rose from 6·9 to 52·3 per 1000 person-years between those with less than 10·0% risk and those with 30·0% or higher predicted risk.InterpretationFor a wide range of blood pressures, the rate of cardiovascular disease and effectiveness of blood pressure drug treatment was mainly determined by predicted risk, with blood pressure thresholds 140/90 mm Hg or 160/100 mm Hg-ubiquitous in most countries-adding little useful information. When medium-term predicted risk is low, there is no urgency to initiate drug treatment, allowing time to attempt non-pharmacological blood pressure reduction.FundingNational Institute for Health Research.

Dataset Information

Prevalence of Hypertension and Cardiovascular Risk According to Blood Pressure Thresholds Used for Diagnosis.

Publications

Prevalence of Hypertension and Cardiovascular Risk According to Blood Pressure Thresholds Used for Diagnosis.

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