CV Risk Should Be Considered When Determining Hypertension Treatment

In addition to blood pressure measurements, cardiovascular disease (CVD) risk factors should also be considered when determining the treatment of patients with hypertension, according to a new analysis.

The conclusions of 2 trials—the Systolic Blood Pressure Intervention Trial (SPRINT) and Heart Outcomes Prevention Evaluation-3 (HOPE-3) trial—were controversial in determining whether lowering systolic blood pressure (SBP) to 120 mm Hg would benefit patients in the general population.
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To assess the representativeness of these 2 trials, the researchers examined data from 14,142 participants aged 20 to 79 years in the 2007-2012 National Health and Nutrition Examination Survey (NHANES), representing 206.9 million US adults.

The researchers estimated the number and characteristics of participants with SBP of 120 mm Hg or higher, including SPRINT and HOPE-3 eligibility, and who may have recently required treatment or required a more intense treatment if various trial or risk-based criteria were applied.

Analysis showed that an estimated 53.3 million untreated Americans and 19.8 million treated Americans have an SBP in the diagnostic and treatment “gray zone” (120-139 mm Hg). Only 5.4% of untreated and 13.9% of treated adults would qualify for SPRINT, and 1.7% of untreated and 13.9% of treated adults would qualify for HOPE-3.

Among those with prior CVD or high risk of CVD and elevated SBP, only 27.0% of untreated and 21.9% of treated adults would be eligible for SPRINT, and 10.6% of untreated and 2.1% of treated adults would be eligible for HOPE-3.

“If blood pressure treatment recommendations were extended to adults with an SBP between 120 and 139 mm Hg, as well as prior CVD or CVD risk of 15% or higher, then 5.8 million untreated adults would be reclassified as treatment eligible,” the researchers concluded. “Furthermore, 8.5 million treated patients would require medication intensification.”

“Millions of US adults have elevated SBP and high CVD risk, most of whom would not have been eligible for SPRINT. Until more definitive evidence becomes available, clinicians should consider a management paradigm based on CVD risk in addition to blood pressure measurements.”

—Amanda Balbi

Reference:
Navar AM, Pencina MJ, Peterson ED. Assessing cardiovascular risk to guide hypertension diagnosis and treatment [published online September 7, 2016]. JAMA Cardiol. doi:10.1001/jamacardio.2016.2861.