Impact of the 2017 AmericanHeart Association and American College of Cardiology hypertension guideline in aged individuals
Objectives: 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 a...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Journal Article |
| Language: | English |
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LIPPINCOTT WILLIAMS & WILKINS
2020
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| Subjects: | |
| Online Access: | https://europepmc.org/article/PMC/8218338 http://hdl.handle.net/20.500.11937/93110 |
| _version_ | 1848765700476239872 |
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| author | Chowdhury, Enayet Ernst, M.E. Nelson, M. Margolis, K. Beilin, L.J. Johnston, C. Woods, R. Murray, A. Wolfe, R. Storey, E. Shah, R.C. Lockery, J. Tonkin, A. Newman, A. Abhayaratna, W. Stocks, N. Fitzgerald, S. Orchard, S. Trevaks, R. Donnan, G. Grimm, R. McNeil, J. Reid, Christopher |
| author_facet | Chowdhury, Enayet Ernst, M.E. Nelson, M. Margolis, K. Beilin, L.J. Johnston, C. Woods, R. Murray, A. Wolfe, R. Storey, E. Shah, R.C. Lockery, J. Tonkin, A. Newman, A. Abhayaratna, W. Stocks, N. Fitzgerald, S. Orchard, S. Trevaks, R. Donnan, G. Grimm, R. McNeil, J. Reid, Christopher |
| author_sort | Chowdhury, Enayet |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | Objectives: 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. Methods: 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 <140/90mmHg 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. Results: 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. Conclusion: 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. |
| first_indexed | 2025-11-14T11:39:25Z |
| format | Journal Article |
| id | curtin-20.500.11937-93110 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| language | English |
| last_indexed | 2025-11-14T11:39:25Z |
| publishDate | 2020 |
| publisher | LIPPINCOTT WILLIAMS & WILKINS |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-931102024-01-18T10:12:41Z Impact of the 2017 AmericanHeart Association and American College of Cardiology hypertension guideline in aged individuals Chowdhury, Enayet Ernst, M.E. Nelson, M. Margolis, K. Beilin, L.J. Johnston, C. Woods, R. Murray, A. Wolfe, R. Storey, E. Shah, R.C. Lockery, J. Tonkin, A. Newman, A. Abhayaratna, W. Stocks, N. Fitzgerald, S. Orchard, S. Trevaks, R. Donnan, G. Grimm, R. McNeil, J. Reid, Christopher Science & Technology Life Sciences & Biomedicine Peripheral Vascular Disease Cardiovascular System & Cardiology elderly guidelines hypertension target blood pressure CARDIOVASCULAR RISK TASK-FORCE Aged Aged, 80 and over Antihypertensive Agents Blood Pressure Cohort Studies Female Heart Disease Risk Factors Humans Hypertension Male Practice Guidelines as Topic ASPREE Investigator Group Humans Hypertension Antihypertensive Agents Cohort Studies Blood Pressure Aged Aged, 80 and over Female Male Practice Guidelines as Topic Heart Disease Risk Factors Objectives: 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. Methods: 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 <140/90mmHg 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. Results: 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. Conclusion: 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. 2020 Journal Article http://hdl.handle.net/20.500.11937/93110 10.1097/HJH.0000000000002582 English https://europepmc.org/article/PMC/8218338 http://purl.org/au-research/grants/nhmrc/1111170 LIPPINCOTT WILLIAMS & WILKINS unknown |
| spellingShingle | Science & Technology Life Sciences & Biomedicine Peripheral Vascular Disease Cardiovascular System & Cardiology elderly guidelines hypertension target blood pressure CARDIOVASCULAR RISK TASK-FORCE Aged Aged, 80 and over Antihypertensive Agents Blood Pressure Cohort Studies Female Heart Disease Risk Factors Humans Hypertension Male Practice Guidelines as Topic ASPREE Investigator Group Humans Hypertension Antihypertensive Agents Cohort Studies Blood Pressure Aged Aged, 80 and over Female Male Practice Guidelines as Topic Heart Disease Risk Factors Chowdhury, Enayet Ernst, M.E. Nelson, M. Margolis, K. Beilin, L.J. Johnston, C. Woods, R. Murray, A. Wolfe, R. Storey, E. Shah, R.C. Lockery, J. Tonkin, A. Newman, A. Abhayaratna, W. Stocks, N. Fitzgerald, S. Orchard, S. Trevaks, R. Donnan, G. Grimm, R. McNeil, J. Reid, Christopher Impact of the 2017 AmericanHeart Association and American College of Cardiology hypertension guideline in aged individuals |
| title | Impact of the 2017 AmericanHeart Association and American College of Cardiology hypertension guideline in aged individuals |
| title_full | Impact of the 2017 AmericanHeart Association and American College of Cardiology hypertension guideline in aged individuals |
| title_fullStr | Impact of the 2017 AmericanHeart Association and American College of Cardiology hypertension guideline in aged individuals |
| title_full_unstemmed | Impact of the 2017 AmericanHeart Association and American College of Cardiology hypertension guideline in aged individuals |
| title_short | Impact of the 2017 AmericanHeart Association and American College of Cardiology hypertension guideline in aged individuals |
| title_sort | impact of the 2017 americanheart association and american college of cardiology hypertension guideline in aged individuals |
| topic | Science & Technology Life Sciences & Biomedicine Peripheral Vascular Disease Cardiovascular System & Cardiology elderly guidelines hypertension target blood pressure CARDIOVASCULAR RISK TASK-FORCE Aged Aged, 80 and over Antihypertensive Agents Blood Pressure Cohort Studies Female Heart Disease Risk Factors Humans Hypertension Male Practice Guidelines as Topic ASPREE Investigator Group Humans Hypertension Antihypertensive Agents Cohort Studies Blood Pressure Aged Aged, 80 and over Female Male Practice Guidelines as Topic Heart Disease Risk Factors |
| url | https://europepmc.org/article/PMC/8218338 https://europepmc.org/article/PMC/8218338 http://hdl.handle.net/20.500.11937/93110 |