Impact of the 2014 Expert Panel Recommendations for Management of High Blood Pressure on Contemporary Cardiovascular Practice: Insights From the National Cardiovascular Data Registry PINNACLE Registry

Nov 19, 2014
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Authors:
Borden WB, Maddox TM, Tang F, et al.
Citation:
J Am Coll Cardiol 2014;Nov 19:[Epub ahead of print].
Summary By:
Debabrata Mukherjee, MD, FACC

Study Questions:

What is the impact of the 2014 expert panel blood pressure management recommendations on patients managed in US ambulatory cardiovascular practices?

Methods:

Using the National Cardiovascular Data Registry (NCDR) Practice Innovation and Clinical Excellence (PINNACLE) Registry, the investigators assessed the proportion of patients who met the 2003 and 2014 panel recommendations, highlighting the populations of patients for whom the blood pressure goals changed.

Results:

Of 1,185,253 patients in the study cohort, 706,859 (59.6%) achieved 2003 Joint National Committee (JNC) 7 goals. Using the 2014 recommendations, 880,378 (74.3%) patients were at goal. Among the 173,519 (14.6%) for whom goal achievement changed, 40,323 (23.2%) had a prior stroke or transient ischemic attack, and 112,174 (64.6%) had coronary artery disease. In addition, the average Framingham risk score in this group was 8.5% (standard deviation [SD] ± 3.2%), and the 10-year atherosclerotic cardiovascular disease risk score was 28.0% (SD ± 19.5%).

Conclusions:

The authors concluded that among US ambulatory cardiology patients with hypertension, nearly one in seven who did not meet JNC 7 recommendations would now meet the 2014 treatment goals.

Perspective:

This analysis, conducted in a real-world cardiology practice clinical registry, demonstrates that about three-quarters of patients with hypertension met the 2014 panel-recommended blood pressure goals, whereas less than two-thirds met the 2003 JNC 7 guideline goals. With the more permissive 2014 blood pressure targets, patients meeting the new goals had significantly higher cardiovascular risk than those meeting the 2003 guidelines. Given the size and underlying cardiovascular risk of the population affected by the changes in the 2014 panel recommendations, close monitoring will be required to assess changes in practice patterns, follow blood pressure control, and importantly, any changes in cardiovascular morbidity and mortality.

Keywords: AHA Annual Scientific Sessions


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