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Clinical Research Study| Volume 131, ISSUE 8, P956-960, August 2018

Baseline Blood Pressure, the 2017 ACC/AHA High Blood Pressure Guidelines, and Long-Term Cardiovascular Risk in SPRINT

  • Author Footnotes
    * Drs. Vaduganathan and Pareek contributed equally as co-first authors of this manuscript.
    Muthiah Vaduganathan
    Footnotes
    * Drs. Vaduganathan and Pareek contributed equally as co-first authors of this manuscript.
    Affiliations
    Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Mass
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  • Author Footnotes
    * Drs. Vaduganathan and Pareek contributed equally as co-first authors of this manuscript.
    Manan Pareek
    Footnotes
    * Drs. Vaduganathan and Pareek contributed equally as co-first authors of this manuscript.
    Affiliations
    Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Mass

    Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Denmark
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  • Arman Qamar
    Affiliations
    Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Mass
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  • Ambarish Pandey
    Affiliations
    Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
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  • Michael H. Olsen
    Affiliations
    Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Denmark

    Cardiology Section, Department of Internal Medicine, Holbaek Hospital, Denmark
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  • Deepak L. Bhatt
    Correspondence
    Requests for reprints should be addressed to Deepak L. Bhatt, MD, MPH, Brigham and Women's Hospital Heart & Vascular Center, 75 Francis St, Boston, MA 02115.
    Affiliations
    Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Mass
    Search for articles by this author
  • Author Footnotes
    * Drs. Vaduganathan and Pareek contributed equally as co-first authors of this manuscript.
Published:February 05, 2018DOI:https://doi.org/10.1016/j.amjmed.2017.12.049

      Abstract

      Background

      The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines include lower thresholds to define hypertension than previous guidelines. Little is known about the impact of these guideline changes in patients with or at high risk for cardiovascular disease.

      Methods

      In this exploratory analysis using baseline blood pressure assessments in Systolic Blood Pressure Intervention Trial (SPRINT), we evaluated the prevalence and associated cardiovascular prognosis of patients newly reclassified with hypertension based on the 2017 ACC/AHA (systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥80 mm Hg) compared with the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7) guidelines (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg). The primary endpoint was the composite of myocardial infarction, other acute coronary syndromes, stroke, heart failure, or cardiovascular death.

      Results

      In 4683 patients assigned to the standard treatment arm of SPRINT, 2328 (49.7%) met hypertension thresholds by JNC 7 guidelines, and another 1424 (30.4%) were newly reclassified as having hypertension based on the 2017 ACC/AHA guidelines. Over 3.3-year median follow-up, 319 patients experienced the primary endpoint (87 of whom were newly reclassified with hypertension based on the revised guidelines). Patients with hypertension based on prior guidelines compared with those newly identified with hypertension based on the new guidelines had similar risk of the primary endpoint (2.3 [95% confidence interval {CI}, 2.0-2.7] vs 2.0 [95% CI, 1.6-2.4] events per 100 patient-years; adjusted HR, 1.10 [95% CI, 0.84-1.44]; P = .48).

      Conclusions

      The 2017 ACC/AHA high blood pressure guidelines are expected to significantly increase the prevalence of patients with hypertension (perhaps to a greater extent in higher-risk patient cohorts compared with the general population) and identify greater numbers of patients who will ultimately experience adverse cardiovascular events.

      Keywords

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