Since 1999, more people with high blood pressure — especially those 60 years of age or older — have visited their healthcare professionals for treatment. Unfortunately, about 1 in 5 U.S. adults remain unaware of their high blood pressure.
More than 360,000 American deaths in 2013 included high blood pressure as a primary or contributing cause, nearly 1,000 deaths each day.
Because of its high prevalence, hypertension remains an important public health concern and a risk factor for adverse health outcomes, including coronary heart disease, stroke, heart failure, chronic kidney disease, and decline in cognitive function.
According to the landmark Systolic Blood Pressure Intervention Trial (SPRINT), intensive blood pressure management may save lives.
The intervention in this trial, which carefully adjusts the amount or type of blood pressure medication to achieve a target systolic pressure of 120 millimeters of mercury (mm Hg), reduced rates of cardiovascular events, such as heart attack and heart failure, as well as stroke, by almost a third and the risk of death by almost a quarter, as compared to the target systolic pressure of 140 mm Hg.
Because of this study, the American College of Cardiology issued new guidelines for high blood pressure, redefining hypertension as blood pressure equal or above 130/80 mm Hg. However, debate is ongoing as to the implications of this change.
In the first of the new studies, Dr. Alexander Leung from the University of Calgary, Canada, and colleagues sought to determine the proportion of Canadian adults who met SPRINT eligibility criteria.An estimated 1.3 million (5.2 percent) Canadian adults met the eligibility criteria — 182,600 people who were not previously considered to have hypertension or need for antihypertensive therapy.
Of adults aged 50-79 years treated for hypertension, 18.7 percent or 754,400 individuals, would potentially benefit from treatment intensification. Implications of these results include more frequent clinic visits, increased drug costs, increased rates of adverse effects, as well as other healthcare expenditures.
In another study, Dr. Remi Goupil from the Hôpital du Sacré-Coeur de Montréal and colleagues examined the differences between the 2017 Hypertension Canada and 2017 American College of Cardiology and American Heart Association (ACC/AHA) blood pressure guidelines by assessing the number of individuals with hypertension, blood pressure above thresholds for treatment initiation, and blood pressure below targets, using the CARTaGENE population-based cohort.
In total, 20,004 individuals 40-69 years of age were selected. Results of this analysis showed that adopting recommendations from the 2017 ACC/AHA guidelines in Canada would result in a substantial increase in diagnoses of hypertension and of individuals requiring drug treatment in Canadians between 40 and 69 of age, resulting in a change in blood pressure targets in a high proportion of hypertensive patients already receiving treatment, and representing nearly 1.25 million more individuals with hypertension and 500,000 more individuals requiring antihypertensive treatment.
Some healthcare professionals feel that undertaking these more aggressive goals needs to be based on thorough discussions with patients that includes all benefits and risks. Ultimately, many patients will benefit from adjustments in blood pressure targets but not without the risk of adverse effects.
All in all, dissemination and implementation are critical. According to Dr. Ross Feldman, medical director of the WRHA Cardiac Sciences Program in Winnipeg, Canada, it is better to have suboptimal guidelines that are followed than it is to have perfectly crafted and up-to-date guidelines that are ignored.
