Skip to main content
construction release_alert
Scholars@Duke will be undergoing maintenance April 11-15. Some features may be unavailable during this time.
cancel

Assessing Cardiovascular Risk to Guide Hypertension Diagnosis and Treatment.

Publication ,  Journal Article
Navar, AM; Pencina, MJ; Peterson, ED
Published in: JAMA Cardiol
November 1, 2016

IMPORTANCE: The Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated the benefit of lowering systolic blood pressure (SBP) to 120 mm Hg, yet other trials, such as Heart Outcomes Prevention Evaluation-3 (HOPE-3), did not find consistent benefit. How to incorporate these results into the treatment of those with elevated SBP in the general population is not clear. OBJECTIVES: To assess the representativeness of SPRINT and HOPE-3 relative to patients in the United States and to explore the cardiovascular disease (CVD) risk profiles of various populations with elevated SBP. DESIGN, SETTING, AND PARTICIPANTS: The study examined data from nonpregnant adults aged 20 to 79 years participating in the 2007-2012 National Health and Nutrition Examination Survey (NHANES) who had complete data available (n = 14 142), representing 206.9 million US adults. The study was performed from October 1, 2015, to August 2, 2016. MAIN OUTCOMES AND MEASURES: The study estimated the number and characteristics of adults with SBP of 120 mm Hg or higher, including SPRINT and HOPE-3 eligibility, and estimated who may have newly required treatment initiation or intensification if various trial or risk-based criteria were applied. RESULTS: NHANES included completed clinical evaluations from mobile examination centers on 15 974 adults aged 20 to 79 years (mean [SD] age, 45.9 [15.5] years). The study excluded 182 pregnant women and 1650 adults in whom CVD risk data were unavailable, leaving a final study population of 14 142 (50.5% women [95% CI, 49.6%-51.3%] and 49.5% men [95% CI, 48.6%-50.4%]). An estimated 53.3 million untreated and 19.8 million treated US adults have an SBP in the diagnostic and treatment gray zone (120-139 mm Hg), a small proportion of whom would have been eligible for SPRINT (5.4% untreated, 13.9% treated) or HOPE-3 (13.9% treated, 1.7% untreated). Even among those with prior CVD or high risk of CVD and elevated SBP (120-139 mm Hg), only a few would have qualified for SPRINT (27.0% and 21.9% of untreated and treated patients, respectively) or HOPE-3 (10.6% and 2.1% of untreated and treated, respectively). 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; furthermore, 8.5 million treated patients would require medication intensification. CONCLUSIONS AND RELEVANCE: 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.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

JAMA Cardiol

DOI

EISSN

2380-6591

Publication Date

November 1, 2016

Volume

1

Issue

8

Start / End Page

864 / 871

Location

United States

Related Subject Headings

  • Young Adult
  • Risk Factors
  • Nutrition Surveys
  • Middle Aged
  • Male
  • Hypertension
  • Humans
  • Female
  • Cardiovascular Diseases
  • Antihypertensive Agents
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Navar, A. M., Pencina, M. J., & Peterson, E. D. (2016). Assessing Cardiovascular Risk to Guide Hypertension Diagnosis and Treatment. JAMA Cardiol, 1(8), 864–871. https://doi.org/10.1001/jamacardio.2016.2861
Navar, Ann Marie, Michael J. Pencina, and Eric D. Peterson. “Assessing Cardiovascular Risk to Guide Hypertension Diagnosis and Treatment.JAMA Cardiol 1, no. 8 (November 1, 2016): 864–71. https://doi.org/10.1001/jamacardio.2016.2861.
Navar AM, Pencina MJ, Peterson ED. Assessing Cardiovascular Risk to Guide Hypertension Diagnosis and Treatment. JAMA Cardiol. 2016 Nov 1;1(8):864–71.
Navar, Ann Marie, et al. “Assessing Cardiovascular Risk to Guide Hypertension Diagnosis and Treatment.JAMA Cardiol, vol. 1, no. 8, Nov. 2016, pp. 864–71. Pubmed, doi:10.1001/jamacardio.2016.2861.
Navar AM, Pencina MJ, Peterson ED. Assessing Cardiovascular Risk to Guide Hypertension Diagnosis and Treatment. JAMA Cardiol. 2016 Nov 1;1(8):864–871.

Published In

JAMA Cardiol

DOI

EISSN

2380-6591

Publication Date

November 1, 2016

Volume

1

Issue

8

Start / End Page

864 / 871

Location

United States

Related Subject Headings

  • Young Adult
  • Risk Factors
  • Nutrition Surveys
  • Middle Aged
  • Male
  • Hypertension
  • Humans
  • Female
  • Cardiovascular Diseases
  • Antihypertensive Agents