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 - Funding Information:
This research was supported by the American College of Cardiology Foundation’s National Cardiovascular Data Registry (NCDR). The views expressed in this paper represent those of the authors and do not necessarily represent the official views of the NCDR or its associated professional societies identified at http://www.ncdr.com . Dr. Borden was supported as a Nanette Laitman Clinical Scholar while he was at Weill Cornell Medical College. Dr. Maddox is supported with a Veterans’ Affairs career development award. Dr. Rumsfeld is the Chief Science Officer for the National Cardiovascular Data Registry. Dr. Peterson has received research financial support from Eli Lilly, Janssen , AstraZeneca , and Boehringer Ingelheim ; and is the principal investigator of one of the NCDR's Data Analytic Centers. Dr. Masoudi is the Senior Medical Officer for the National Cardiovascular Data Registry; and has a contract with the American College of Cardiology. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Funding Information:
In 2003, the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) was widely implemented by the medical community (1) . This report established blood pressure goals of <140/90 mm Hg for the general population and <130/80 mm Hg for patients with diabetes and/or chronic kidney disease. A follow-up Eighth Joint National Committee (JNC-8) guideline was initially drafted with funding from the National Heart, Lung, and Blood Institute. The National Heart, Lung, and Blood Institute ultimately decided not to proceed with the updated guideline, instead focusing on research and providing support for professional societies to write their own advisories (2) . However, the expert panel members who were initially appointed to JNC-8 chose to independently publish their recommendations. The primary difference between JNC-7 guidelines and the 2014 panel recommendations was the raising of some of the blood pressure treatment targets (3) , including revised targets of <150/90 mm Hg for patients age 60 years and older and <140/90 mm Hg for those with diabetes and/or chronic kidney disease.
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
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U2 - 10.1016/j.jacc.2014.09.022
DO - 10.1016/j.jacc.2014.09.022
M3 - Article
C2 - 25447261
AN - SCOPUS:84921660911
VL - 64
SP - 2196
EP - 2203
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
SN - 0735-1097
IS - 21
ER -