Author + information
- Received February 20, 2018
- Revision received May 11, 2018
- Accepted May 16, 2018
- Published online September 3, 2018.
- Lisandro D. Colantonio, MD, PhDa,∗ (, )@lcolantonio,
- John N. Booth III, PhDa,
- Adam P. Bress, PharmD, MSb,
- Paul K. Whelton, MB, MD, MScc,
- Daichi Shimbo, MDd,
- Emily B. Levitan, ScDa,
- George Howard, DrPHe,
- Monika M. Safford, MDf and
- Paul Muntner, PhDa
- aDepartment of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
- bDepartment of Population Health Sciences, University of Utah, Salt Lake City, Utah
- cDepartment of Epidemiology, Tulane University, New Orleans, Louisiana
- dDepartment of Medicine, Columbia University, New York, New York
- eDepartment of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
- fDepartment of Medicine, Weill Cornell Medical College, New York, New York
- ↵∗Address for correspondence:
Dr. Lisandro D. Colantonio, 1720 2nd Avenue South, RPHB 527C, Birmingham, Alabama 35294-0013.
Background The 2017 American College of Cardiology/American Heart Association (ACC/AHA) blood pressure (BP) guideline provides updated recommendations for antihypertensive medication initiation and intensification.
Objectives Determine the risk for cardiovascular disease (CVD) events among adults recommended and not recommended antihypertensive medication initiation or intensification by the 2017 ACC/AHA BP guideline.
Methods The authors analyzed data for black and white REGARDS (REasons for Geographic And Racial Differences in Stroke) study participants (age ≥45 years). Systolic BP (SBP) and diastolic BP (DBP) were measured twice at baseline (2003 to 2007) and averaged. Participants not taking (n = 14,039) and taking (n = 15,179) antihypertensive medication were categorized according to their recommendations for antihypertensive medication initiation and intensification by the 2017 ACC/AHA guideline. Overall, 4,094 CVD events (stroke, coronary heart disease, and heart failure) occurred by December 31, 2014.
Results Among participants not taking antihypertensive medication, 34.4% were recommended pharmacological antihypertensive treatment initiation. The CVD event rate per 1,000 person-years among participants recommended antihypertensive medication initiation with SBP/DBP ≥140/90 mm Hg was 22.7 (95% confidence interval [CI]: 20.3 to 25.0). Among participants with SBP/DBP 130 to 139/80 to 89 mm Hg, the CVD event rate was 20.5 (95% CI: 18.5 to 22.6) and 3.4 (95% CI: 2.4 to 4.4) for those recommended and not recommended antihypertensive medication initiation, respectively. Among participants taking antihypertensive medication, 62.8% were recommended treatment intensification. The CVD event rate per 1,000 person-years among participants recommended treatment intensification was 33.6 (95% CI: 31.5 to 35.6) and 22.4 (95% CI: 20.8 to 23.9) for those with SBP/DBP ≥140/90 mm Hg and 130 to 139/80 to 89 mm Hg, respectively.
Conclusions Implementing the 2017 ACC/AHA guideline would direct antihypertensive medication initiation and intensification to adults with high CVD risk.
This research project is supported by cooperative agreement U01 NS041588 from the National Institute of Neurological Disorders and Stroke, National Institutes of Health. Representatives of the funding agency have been involved in the review of the manuscript but not directly involved in the collection, management, analysis, or interpretation of the data. Additional support was provided by grants R01 HL080477, 1K01HL133468, K24 HL125704, and K24 HL111154 from the National Heart, Lung, and Blood Institute, 15SFRN2390002 from the American Heart Association, and P20GM109036 (Tulane COBRE for Clinical and Translational Research in Cardiometabolic Diseases) from the National Institute of General Medical Sciences. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Neurological Disorders and Stroke or the National Institutes of Health. Dr. Booth has received support from American Heart Association Strategically Focused Research Network grant 15SFRN2390002. Dr. Bress has received research support to his institution from Novartis. Dr. Levitan has received research support from and served on advisory boards for Amgen; and has been a consultant for Novartis. Dr. Safford has received research support from Amgen. Dr. Muntner has received research support and honoraria from Amgen. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 20, 2018.
- Revision received May 11, 2018.
- Accepted May 16, 2018.
- 2018 American College of Cardiology Foundation