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Potential CVD Events Prevented With Adoption of 2017 ACC/AHA BP Guideline
Study Questions:
What are the estimated number of cardiovascular disease (CVD) events prevented and treatment-related serious adverse events incurred over 10 years among US adults with hypertension by achieving 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline-recommended blood pressure (BP) goals compared with: 1) current BP levels, 2) achieving 2003 Seventh Joint National Committee (JNC) Report BP goals, and 3) achieving 2014 Eighth JNC panel member report BP goals?
Methods:
US adults ages ≥45 years with an indication for BP treatment were grouped according to recommendations for antihypertensive drug therapy in the 2017 ACC/AHA guideline, 2003 Seventh JNC Report, and 2014 Eighth JNC. Population sizes were estimated from the 2011-2014 National Health and Nutrition Examination Surveys. Rates for fatal and nonfatal CVD events (stroke, coronary heart disease, or heart failure) were estimated from the REGARDS (REasons for Geographic And Racial Differences in Stroke) study, weighted to the US population. CVD risk reductions with treatment to BP goals and risk for serious adverse events were obtained from meta-analyses of BP-lowering trials. CVD events prevented and treatment-related nonfatal serious adverse events over 10 years were calculated. Uncertainty surrounding main data inputs was expressed in uncertainty ranges (UR). Among the more serious adverse events were hypotension, syncope, bradycardia, electrolyte abnormalities, injurious falls, and acute kidney injury.
Results:
Over 10 years, achieving and maintaining 2017 ACC/AHA guideline goals compared with current BP levels, achieving 2003 Seventh JNC Report goals, or achieving 2014 Eighth JNC goals could prevent 3.0 million (UR, 1.1–5.1 million), 0.5 million (UR, 0.2–0.7 million), or 1.4 million (UR, 0.6–2.0 million) CVD events, respectively. Compared with current BP levels, achieving and maintaining 2017 goals could prevent 71.9 (UR, 26.6–122.3) CVD events per 1,000 treated. Achieving 2017 guideline BP goals compared with current BP levels could also lead to nearly 3.3 million more serious adverse events over 10 years (UR, 2.2–4.4 million).
Conclusions:
Achieving and maintaining 2017 ACC/AHA BP goals could prevent a greater number of CVD events than achieving 2003 Seventh JNC Report or 2014 Eighth JNC BP goals, but could also lead to more serious adverse events.
Perspective:
The 2017 ACC/AHA BP goals could prevent about twice as many CV events as that of the 2014 JNC. The magnitude of bias and differences in bias contribute to the results, particularly adverse events. The adverse events are for the most part not serious, but the implications are not determinable; for example, the number and impact to the individuals of emergency room visits for falls and syncope and the frequency with which patients would refuse to take medication after an adverse event. Clearly, patient reliability and willingness to obtain home BPs per protocol should be considered when deciding on BP goals.
Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Implantable Devices, Acute Heart Failure, Hypertension
Keywords: Accidental Falls, Acute Kidney Injury, Antihypertensive Agents, Blood Pressure, Bradycardia, Coronary Disease, Electrolytes, Heart Failure, Hypertension, Primary Prevention, Risk Factors, Stroke, Syncope
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