In a nutshell
This study looked at the different guidelines on blood pressure control for hypertensive patients and examined the link cardiovascular risk. The authors concluded that the 10-year risk of cardiovascular events such as stroke and heart attacks were lower in patients meeting stricter guidelines.
Some background
Patients with hypertension need to lower their blood pressure (BP) to reduce the risk of cardiovascular complications such as heart attacks, strokes, and heart failure. There are different guidelines on the recommended BP levels. In a BP reading, the systolic number (pressure when the heart is contracting) always comes first, and then the diastolic number (pressure when the heart is between beats).
One set of recommendations from 2014 suggests that controlled BP is 150/90 mm Hg for adults over 60 and 140/90 mm Hg for younger adults and patients with diabetes or chronic kidney disease. A more recent set of recommendations was drawn up following a trial (called SPRINT). The SPRINT recommendations suggests that SBP should be lowered to below 120 mm Hg.
These recommendations contradict each other and it is unknown how this will affect the cardiovascular risk in patients adhering to the less strict controls.
Methods & findings
The records of 67,965 hypertensive patients were analyzed. The authors recorded the number of patients with BP below the SPRINT guidelines (intensive group), those with BP below the 2014 guidelines but not the SPRINT guidelines (less-intensive group), and those who had BP above both guidelines (uncontrolled group). The risk of stroke, heart attack, and mortality was calculated for each group and predicted over a 10-year period. The average follow-up period was 6 to 6.6 years.
11.9% of patients met the SPRINT guidelines. 70.8% of patients met the less strict 2014 guidelines.
The estimated 10-year cardiovascular risk was 6.15% in the intensive group. This was significantly lower compared to less-intensive group (7.65%) and the uncontrolled group (9.39%). Overall, the risk of a major cardiovascular event was 17% higher in the less-intensive group and 62% higher in the uncontrolled group when compared to the intensive group.
The bottom line
The authors concluded that stricter blood pressure control is associated with a decreased risk of major cardiovascular events.
The fine print
The findings of this study depend on the accuracy of the databases analyzed.
Published By :
Journal of the American College of Cardiology
Date :
Jun 21, 2016
