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

Enayet Karim Chowdhury; Michael E Ernst; Mark Nelson; Karen Margolis; Lawrie J Beilin; Collin Johnston; Robyn Woods; Anne Murray; Rory Wolfe; Elsdon Storey; Raj C Shah; Jessica Lockery; Andrew Tonkin; Anne Newman; Walter Abhayaratna; Nigel Stocks; Sharyn Fitzgerald; Suzanne Orchard; Ruth Trevaks; Geoffrey Donnan; R Grimm; John McNeil; Christopher M Reid; ASPREE Investigator Group

doi:10.1097/HJH.0000000000002582

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

Journal article

Peer reviewed

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

Enayet Karim Chowdhury, Michael E Ernst, Mark Nelson, Karen Margolis, Lawrie J Beilin, Collin Johnston, Robyn Woods, Anne Murray, Rory Wolfe, Elsdon Storey, …

Journal of hypertension, Vol.38(12), pp.2527-2536

12/2020

DOI: 10.1097/HJH.0000000000002582

PMCID: PMC8218338

PMID: 32740404

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https://www.ncbi.nlm.nih.gov/pmc/articles/8218338View

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Abstract

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. 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 <130 and <80 mmHg). For each group, we evaluated CVD risk factors, predicted 10-year CVD risk using the Atherosclerotic Cardiovascular Disease (ASCVD) risk equation, and reported observed CVD event rates during a median 4.7-year follow-up. 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 < 0.001) and lower CVD rates (8.9 versus 12.1/1000 person-years, 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. 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.

Aged

Aged, 80 and over

Antihypertensive Agents - administration & dosage

Antihypertensive Agents - therapeutic use

Blood Pressure - physiology

Cohort Studies

Female

Heart Disease Risk Factors

Humans

Hypertension - drug therapy

Male

Practice Guidelines as Topic

Details

Title: Subtitle: Impact of the 2017 American Heart Association and American College of Cardiology hypertension guideline in aged individuals
Creators: Enayet Karim Chowdhury - Curtin University
Michael E Ernst - University of Iowa
Mark Nelson - Monash University
Karen Margolis - HealthPartners
Lawrie J Beilin - Royal Perth Hospital
Collin Johnston - Baker Heart and Diabetes Institute
Robyn Woods - Monash University
Anne Murray - Hennepin Healthcare Research Institute
Rory Wolfe - Monash University
Elsdon Storey - Monash University
Raj C Shah - Rush University Medical Center
Jessica Lockery - Monash University
Andrew Tonkin - Monash University
Anne Newman - University of Pittsburgh
Walter Abhayaratna - Australian National University
Nigel Stocks - The University of Adelaide
Sharyn Fitzgerald - Monash University
Suzanne Orchard - Monash University
Ruth Trevaks - Monash University
Geoffrey Donnan - Florey Institute of Neuroscience and Mental Health
R Grimm - Hennepin Healthcare Research Institute
John McNeil - Monash University
Christopher M Reid - Monash University
ASPREE Investigator Group
Resource Type: Journal article
Publication Details: Journal of hypertension, Vol.38(12), pp.2527-2536
DOI: 10.1097/HJH.0000000000002582
PMID: 32740404
PMCID: PMC8218338
NLM abbreviation: J Hypertens
ISSN: 0263-6352
eISSN: 1473-5598
Grant note: U01 AG029824 / NIA NIH HHS U19 AG062682 / NIA NIH HHS P30 AG024824 / NIA NIH HHS
Language: English
Date published: 12/2020
Academic Unit: Family and Community Medicine; Pharmacy Practice and Science
Record Identifier: 9984297334002771

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