Incidence of cardiovascular disease in individuals affected by recent changes to US blood pressure treatment guidelines

Abstract

Objective We evaluated the incidence of cardiovascular disease (CVD) in individuals whose blood pressure (BP) management strategy would change with adoption of recent US hypertension guidelines in two large, community-based cohorts with different racial and geographic compositions: the Framingham and Jackson Heart Studies (FHS and JHS). Methods We assigned 11,237 FHS (mean age 46, 53% women) and 2948 JHS (mean age 55, 69% women) participants free of chronic kidney disease to one of five categories representing different treatment recommendations between JNC 8 and JNC 7 guidelines. Absolute incidence rates (IR; per 1000 person-years) and multivariable-adjusted hazard ratios (HR) were calculated for each group; cohort-specific results were combined using fixed effect meta-analysis. Results CVD events occurred in 1047 FHS and 230 JHS participants during mean follow-up times of 11 and 8.9 years, respectively. Compared to individuals without hypertension, those with BP 140-149/<90 mm Hg had increased risk for CVD regardless of treatment status (HR for untreated BP 140-149/<90 mm Hg 1.96, 95% confidence interval [CI] 1.40-2.75; HR for treated BP 140-149/<90 mm Hg 3.37, 95% CI 2.37-4.78). The risk for those with treated BP 140-149/<90 mm Hg was consistent in those aged ≥60 years (HR: 2.61, 95% CI 1.75-3.90). Statistical power was limited to evaluate the effect of diabetes. Conclusions Individuals with treated BP 140-149/<90 mm Hg have increased risk of CVD compared with those without hypertension including in participants ≥60 years. The JNC 8 recommendations to treat BP levels less aggressively may be associated with substantial residual CVD risk.

Blood pressure targets in the elderly

“…Such data will always have to be interpreted with caution as they do not derive from randomised controlled trials but they can inform the discussion. In this sense the data by Nayor et al [10] are important albeit probably not surprising. They have, however, been derived from contemporary US American population cohorts and should have particular relevance to the JNC that in the first instance addresses the situation in the USA.…”

“…In this issue of the Journal of Hypertension we find further data on blood pressure targets in the elderly in an article by Nayor et al [10]. The authors have modelled in two large general population cohorts, the Framingham (FHS) and Jackson Heart Studies (JHS), the incidence of cardiovascular events in people above the age of 60 years with blood pressure (treated or untreated) in the range of 140-149 mmHg systolic and <90 mmHg diastolic.…”

“…We recommend the reader to critically assess the evidence provided in the article by Nayor et al [10]. There are strengths and weaknesses but in the light of decades of discussions on blood pressure targets it cannot be the task of this editorial to add further arguments.…”

“…A few issues in the article by Nayor et al [10], however, deserve special attention. First, the data derive from two cohorts with different blood pressure measurement protocols.…”

Prostaglandin Levels in Gingival Crevicular Fluid in Periodontitis Patient With Hypertension

“…This number has increased in recent years from 600 million people in 1980 to a billion people in 2008 [1]. The highest prevalence of hypertension was found in the African region, which was estimated at 46% in adults aged ≥25 years, whereas the lowest prevalence was found in the United States of America at 35% [2]. A study mentioned that cases of hypertension that have been diagnosed by health personnel or people taking anti-hypertension drugs remain low in Indonesia at 24.2%, suggesting that 75.8% of hypertension cases in the community have not been identified by the health service [3].…”