In the Journals

New BP guideline diagnoses more stroke survivors with hypertension

The 2017 American College of Cardiology/American Heart Association hypertension guideline may increase the number of U.S. patients who survived a stroke and were diagnosed with hypertension compared with a previous guideline, according to a study published in the Journal of the American Heart Association.

“The new guideline offers physicians and policymakers a unique opportunity to reinforce the already decreasing stroke-related mortality trends of the last few decades,” Alain Lekoubou, MD, MSc, clinical instructor in neurology at the Medical University of South Carolina in Charleston, said in a press release. “It is our responsibility to ensure that stroke survivors identified with hypertension are treated more aggressively and to ensure that those on treatment remain on treatment.”

Researchers analyzed National Health and Nutrition Examination Survey data from 2003 to 2014 of 6,250,751 patients with stroke (42% men). History of stroke was self-reported by a health care provider, and information on pharmacological treatment of hypertension was self-reported by the patient.

The seventh report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7) defined hypertension as systolic BP greater than 140 mm Hg or diastolic BP greater than 90 mm Hg. In the 2017 ACC/AHA guidelines, hypertension was defined as systolic BP greater than 130 mm Hg or diastolic BP greater than 80 mm Hg.

More patients who survived stroke met the criteria for hypertension and would be recommended pharmacological treatment with the ACC/AHA guidelines (49.8%; 95% CI, 45.4-54.2) compared with the JNC7 guidelines (29.9%; 95% CI, 26.2-33.7).

According to the 2017 ACC/AHA guidelines, 56% of patients who survived stroke were taking antihypertensive medications for a BP above goal (95% CI, 51.2-60.6). In contrast, 36.3% of patients who survived stroke were on antihypertensive medication based on the JNC7 guidelines (95% CI, 31.6-41.4).

“The societal gain if the new guidelines were fully implemented would be reflected in the lower stroke recurrence rate, as suggested by prior studies that have found that every reduction of 1 mm Hg of BP was associated with a 4% reduction in stroke recurrence,” Lekoubou and colleagues wrote. “Although there may be several barriers to implementing these new guidelines, financial burden is arguably one of the most important hurdles to putting these guidelines into practice. Subsequent simulation analyses from the SPRINT do suggest that intensive BP control would be cost-effective in the mid- and long-term. Subsequent evaluations of the level of adherence to the new guidelines among stroke survivors as well as short- and long-term economic cost analyses are needed.” – by Darlene Dobkowski

Disclosures: The authors report no relevant financial disclosures.

The 2017 American College of Cardiology/American Heart Association hypertension guideline may increase the number of U.S. patients who survived a stroke and were diagnosed with hypertension compared with a previous guideline, according to a study published in the Journal of the American Heart Association.

“The new guideline offers physicians and policymakers a unique opportunity to reinforce the already decreasing stroke-related mortality trends of the last few decades,” Alain Lekoubou, MD, MSc, clinical instructor in neurology at the Medical University of South Carolina in Charleston, said in a press release. “It is our responsibility to ensure that stroke survivors identified with hypertension are treated more aggressively and to ensure that those on treatment remain on treatment.”

Researchers analyzed National Health and Nutrition Examination Survey data from 2003 to 2014 of 6,250,751 patients with stroke (42% men). History of stroke was self-reported by a health care provider, and information on pharmacological treatment of hypertension was self-reported by the patient.

The seventh report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7) defined hypertension as systolic BP greater than 140 mm Hg or diastolic BP greater than 90 mm Hg. In the 2017 ACC/AHA guidelines, hypertension was defined as systolic BP greater than 130 mm Hg or diastolic BP greater than 80 mm Hg.

More patients who survived stroke met the criteria for hypertension and would be recommended pharmacological treatment with the ACC/AHA guidelines (49.8%; 95% CI, 45.4-54.2) compared with the JNC7 guidelines (29.9%; 95% CI, 26.2-33.7).

According to the 2017 ACC/AHA guidelines, 56% of patients who survived stroke were taking antihypertensive medications for a BP above goal (95% CI, 51.2-60.6). In contrast, 36.3% of patients who survived stroke were on antihypertensive medication based on the JNC7 guidelines (95% CI, 31.6-41.4).

“The societal gain if the new guidelines were fully implemented would be reflected in the lower stroke recurrence rate, as suggested by prior studies that have found that every reduction of 1 mm Hg of BP was associated with a 4% reduction in stroke recurrence,” Lekoubou and colleagues wrote. “Although there may be several barriers to implementing these new guidelines, financial burden is arguably one of the most important hurdles to putting these guidelines into practice. Subsequent simulation analyses from the SPRINT do suggest that intensive BP control would be cost-effective in the mid- and long-term. Subsequent evaluations of the level of adherence to the new guidelines among stroke survivors as well as short- and long-term economic cost analyses are needed.” – by Darlene Dobkowski

Disclosures: The authors report no relevant financial disclosures.