TY - JOUR
T1 - Impact of the 2014 expert panel recommendations for management of high blood pressure on contemporary cardiovascular practice
T2 - Insights from the NCDR PINNACLE registry
AU - Borden, William B.
AU - Maddox, Thomas M.
AU - Tang, Fengming
AU - Rumsfeld, John S.
AU - Oetgen, William J.
AU - Mullen, J. Brendan
AU - Spinler, Sarah A.
AU - Peterson, Eric D.
AU - Masoudi, Frederick A.
N1 - Publisher Copyright:
© 2014 American College of Cardiology Foundation.
PY - 2014/12/2
Y1 - 2014/12/2
N2 - Background Since 2003, the Seventh Report of the Joint National Committee (JNC-7) has been the predominant guideline for blood pressure management. A 2014 expert panel recommended increasing the blood pressure targets for patients age 60 years and older, as well as those with diabetes or chronic kidney disease. Objectives The purpose of this study was to examine the effect of the 2014 expert panel blood pressure management recommendations on patients managed in U.S. ambulatory cardiovascular practices. Methods Using the National Cardiovascular Data Registry PINNACLE Registry, we assessed the proportion of patients who met the 2003 and 2014 panel recommendations, highlighting the populations of patients for whom the blood pressure goals changed. Results Of 1,185,253 patients in the study cohort, 706,859 (59.6%) achieved the 2003 JNC-7 goals. Using the 2014 recommendations, 880,378 (74.3%) patients were at goal. Among the 173,519 (14.6%) for whom goal achievement changed, 40,323 (23.2%) had a prior stroke or transient ischemic attack, and 112,174 (64.6%) had coronary artery disease. In addition, the average Framingham risk score in this group was 8.5 ± 3.2%, and the 10-year ASCVD risk score was 28.0 ± 19.5%. Conclusions Among U.S. ambulatory cardiology patients with hypertension, nearly 1 in 7 who did not meet JNC-7 recommendations would now meet the 2014 treatment goals. If the new recommendations are implemented in clinical practice, blood pressure target achievement and cardiovascular events will need careful monitoring, because many patients for whom the target blood pressure is now more permissive are at high cardiovascular risk.
AB - Background Since 2003, the Seventh Report of the Joint National Committee (JNC-7) has been the predominant guideline for blood pressure management. A 2014 expert panel recommended increasing the blood pressure targets for patients age 60 years and older, as well as those with diabetes or chronic kidney disease. Objectives The purpose of this study was to examine the effect of the 2014 expert panel blood pressure management recommendations on patients managed in U.S. ambulatory cardiovascular practices. Methods Using the National Cardiovascular Data Registry PINNACLE Registry, we assessed the proportion of patients who met the 2003 and 2014 panel recommendations, highlighting the populations of patients for whom the blood pressure goals changed. Results Of 1,185,253 patients in the study cohort, 706,859 (59.6%) achieved the 2003 JNC-7 goals. Using the 2014 recommendations, 880,378 (74.3%) patients were at goal. Among the 173,519 (14.6%) for whom goal achievement changed, 40,323 (23.2%) had a prior stroke or transient ischemic attack, and 112,174 (64.6%) had coronary artery disease. In addition, the average Framingham risk score in this group was 8.5 ± 3.2%, and the 10-year ASCVD risk score was 28.0 ± 19.5%. Conclusions Among U.S. ambulatory cardiology patients with hypertension, nearly 1 in 7 who did not meet JNC-7 recommendations would now meet the 2014 treatment goals. If the new recommendations are implemented in clinical practice, blood pressure target achievement and cardiovascular events will need careful monitoring, because many patients for whom the target blood pressure is now more permissive are at high cardiovascular risk.
KW - CAD guidelines
KW - hypertension
KW - prevention
KW - stroke
UR - http://www.scopus.com/inward/record.url?scp=84921660911&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2014.09.022
DO - 10.1016/j.jacc.2014.09.022
M3 - Article
C2 - 25447261
AN - SCOPUS:84921660911
SN - 0735-1097
VL - 64
SP - 2196
EP - 2203
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 21
ER -