New Guidelines Target Pharmacological Hypertension Management to High-Risk Patients

Monitoring blood pressure with a sphygmomanometer.
Monitoring blood pressure with a sphygmomanometer.
A guideline-based approach directing pharmacological treatment to adults more likely to have CVD events may maximize absolute risk reduction of treatment.

Patients who were recommended antihypertensive therapy according to the new American College of Cardiology (ACC) and the American Heart Association (AHA) blood pressure treatment guidelines had higher rates of cardiovascular events than patients who were not recommended to start therapy, according to the results of a new study published in the Journal of the American College of Cardiology.

Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured at baseline for participants enrolled in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Patients were then categorized into 1 of 2 groups dependent on whether the new ACC/AHA blood pressure treatment guidelines recommended antihypertensive therapy, and rates of cardiovascular disease (CVD) events such as stroke, coronary heart disease, and heart failure were compared between groups.

Overall, 4094 CVD events occurred. Among the 29,218 study participants, 15,719 participants were currently taking antihypertensive medication, and 14,039 were not. Among participants not taking antihypertensive medication, 34.4% were recommended treatment initiation, according to the new guidelines.

The event rate per 1000 person-years among participants recommended medication initiation with blood pressure >140/90 mm Hg was 22.7. Among participants with blood pressures between 130/80 mm Hg and 139/89 mm Hg, the CVD event rate was 20.5 for patients recommended antihypertensive medication initiation, and only 3.4 for patients not recommended medication initiation.

Among the 15,719 participants currently taking antihypertensive medication, 62.8% were recommended for treatment intensification. The event rate among participants recommended for treatment intensification was 33.6 for individuals with blood pressures >140/90 mm Hg and 22.4 for individuals with blood pressures between 130/80 mm Hg and 139/89 mm Hg.

The study authors wrote, “[T]he rate of CVD events and all-cause mortality among participants not taking antihypertensive medication with an average SBP between 130 and 139 mm Hg or DBP between 80 and 89 mm Hg was 6-fold higher for those recommended [vs] not recommended pharmacological treatment initiation by the 2017 ACC/AHA BP guideline.”

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“This (guideline) approach was taken to direct pharmacological treatment to adults more likely to have CVD events and, therefore, maximize absolute risk reduction and quality-adjusted life-years saved from initiation of antihypertensive medication.”


Colantonio L, Booth JN III, Bress A, et al. 2017 ACC/AHA blood pressure treatment guideline recommendations and cardiovascular riskJ Am Coll Cardiol. 2018;72(11):1187-1197.