Cardiovascular Disease and Mortality in Adults Aged ≥60 Years According to Recommendations by the American College of Cardiology/American Heart Association and American College of Physicians/American Academy of Family Physicians

Byron C. Jaeger, D. Edmund Anstey, Adam P. Bress, John N. Booth, Mark Butler, Donald Clark, George Howard, Jolaade Kalinowski, D. Leann Long, Gbenga Ogedegbe, Timothy B. Plante, Daichi Shimbo, Mario Sims, Mark A. Supiano, Paul K. Whelton, Paul Muntner

Research output: Contribution to journalArticle

Abstract

In 2017, the American College of Cardiology/American Heart Association (ACC/AHA) and the American College of Physicians/American Academy of Family Physicians (ACP/AAFP) published blood pressure guidelines. Adults recommended antihypertensive medication initiation or intensification by the ACP/AAFP guideline receive the same recommendation from the ACC/AHA guideline. However, many adults ≥60 years old are recommended to initiate or intensify antihypertensive medication by the ACC/AHA but not the ACP/AAFP guideline. We compared atherosclerotic cardiovascular disease event rates according to antihypertensive treatment recommendations in the ACC/AHA and ACP/AAFP guidelines among adults ≥60 years old with systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥80 mm Hg in the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) and the JHS (Jackson Heart Study). Among 4311 participants not taking antihypertensive medication at baseline, 11.4%, 61.2%, and 27.4% were recommended antihypertensive medication initiation by neither guideline, the ACC/AHA but not the ACP/AAFP guideline, and both guidelines, respectively. Atherosclerotic cardiovascular disease event rates (95% CI) for these groups were 3.4 (1.6-5.2), 18.0 (16.1-19.8), and 25.3 (21.9-28.6) per 1000 person-years, respectively. Among 7281 participants taking antihypertensive medication at baseline, 57.9% and 42.1% were recommended antihypertensive medication intensification by the ACC/AHA but not the ACP/AAFP guideline and both guidelines, respectively. Atherosclerotic cardiovascular disease event rates (95% CI) for these groups were 18.2 (16.7-19.7) and 33.0 (30.5-35.4) per 1000 person-years, respectively. In conclusion, adults recommended initiation or intensification of antihypertensive medication by the ACC/AHA but not the ACP/AAFP guideline have high atherosclerotic cardiovascular disease risk that may be reduced through treatment initiation or intensification.

Original languageEnglish (US)
Pages (from-to)327-334
Number of pages8
JournalHypertension
Volume73
Issue number2
DOIs
StatePublished - 2019

Keywords

  • adults
  • blood pressure
  • coronary heart disease
  • hypertension
  • stroke

ASJC Scopus subject areas

  • Internal Medicine

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    Jaeger, B. C., Anstey, D. E., Bress, A. P., Booth, J. N., Butler, M., Clark, D., Howard, G., Kalinowski, J., Long, D. L., Ogedegbe, G., Plante, T. B., Shimbo, D., Sims, M., Supiano, M. A., Whelton, P. K., & Muntner, P. (2019). Cardiovascular Disease and Mortality in Adults Aged ≥60 Years According to Recommendations by the American College of Cardiology/American Heart Association and American College of Physicians/American Academy of Family Physicians. Hypertension, 73(2), 327-334. https://doi.org/10.1161/HYPERTENSIONAHA.118.12291