Blood pressure control and complex health conditions in older adults: impact of recent hypertension management guidelines.
Journal
Journal of human hypertension
ISSN: 1476-5527
Titre abrégé: J Hum Hypertens
Pays: England
ID NLM: 8811625
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
received:
11
12
2019
accepted:
25
03
2020
revised:
24
03
2020
pubmed:
30
4
2020
medline:
3
9
2021
entrez:
30
4
2020
Statut:
ppublish
Résumé
The American College of Cardiology and the American Heart Association (ACC/AHA) 2017 guidelines for hypertension management lowered blood pressure (BP) thresholds to 130/80 mmHg to define hypertension while the European Society of Cardiology and the European Society of Hypertension (ESC/ESH) 2018 guidelines retained 140/90 mmHg. Both guidelines recommend adapting management for older patients with complex health conditions, without however clear indications on how to adapt. Our aims were to assess the impact of lowering BP thresholds on the prevalence of elevated BP and BP control, as well as the proportion of participants with a complex health condition across these BP categories. We used data from 3210 participants in the Lausanne cohort Lc65+ aged between 67 and 80 years. Hypertension diagnosis and antihypertensive medication use were self-reported. BP was measured three times at one visit. Some 51% of participants reported having hypertension and 44% reported taking antihypertensive medication. Compared with ESC/ESH thresholds, the prevalence of measured elevated BP was 24% percentage points higher and BP control was 24% percentage points lower using ACC/AHA thresholds. About one out of two participants with elevated BP and four out of five participants with uncontrolled BP had a complex health condition, i.e., frailty, multimorbidity, or polypharmacy. To comply with ACC/AHA guidelines, considerable effort would be required to reach BP control. This is a serious challenge because a large share of hypertensive older adults has complex health conditions, a type of patients for whom there is no strong evidence on how to manage hypertension.
Identifiants
pubmed: 32346124
doi: 10.1038/s41371-020-0334-4
pii: 10.1038/s41371-020-0334-4
doi:
Substances chimiques
Antihypertensive Agents
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
280-289Références
Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:1269–324.
doi: 10.1161/HYP.0000000000000066
Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39:3021–104.
doi: 10.1093/eurheartj/ehy339
Anker D, Santos-Eggimann B, Santschi V, Del Giovane C, Wolfson C, Streit S, et al. Screening and treatment of hypertension in older adults: less is more? Public Health Rev. 2018;39:26.
doi: 10.1186/s40985-018-0101-z
Karmali KN, Lloyd-Jones DM, van der Leeuw J, Goff DC Jr., Yusuf S, Zanchetti A, et al. Blood pressure-lowering treatment strategies based on cardiovascular risk versus blood pressure: a meta-analysis of individual participant data. PLoS Med. 2018;15:e1002538.
doi: 10.1371/journal.pmed.1002538
Khera R, Lu Y, Lu J, Saxena A, Nasir K, Jiang L, et al. Impact of 2017 ACC/AHA guidelines on prevalence of hypertension and eligibility for antihypertensive treatment in United States and China: nationally representative cross sectional study. BMJ. 2018;362:k2357.
doi: 10.1136/bmj.k2357
Gijon-Conde T, Sanchez-Martinez M, Graciani A, Cruz JJ, Lopez-Garcia E, Ortola R, et al. Impact of the European and American guidelines on hypertension prevalence, treatment, and cardiometabolic goals. J Hypertens. 2019;37:1393–400.
doi: 10.1097/HJH.0000000000002065
Wilt TJ, Kansagara D, Qaseem A.Clinical Guidelines Committee of the American College of Physicians Hypertension limbo: balancing benefits, harms, and patient preferences before we lower the bar on blood pressure. Ann Intern Med. 2018;168:369–70.
doi: 10.7326/M17-3293
Lewington S, Clarke R, Qizilbash N, Peto R, Collins R, Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903–13.
doi: 10.1016/S0140-6736(02)11911-8
Williamson JD, Supiano MA, Applegate WB, Berlowitz DR, Campbell RC, Chertow GM, et al. Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged ≥75 years: a randomized clinical trial. JAMA. 2016;315:2673–82.
doi: 10.1001/jama.2016.7050
Husten L. Search results for: SPRINT. 2017. In: CardioBrief. http://www.cardiobrief.org/?s=SPRINT .
Richmond R, Law J, Kay-Lambkin F. Higher blood pressure associated with higher cognition and functionality among centenarians in Australia. Am J Hypertens. 2011;24:299–303.
doi: 10.1038/ajh.2010.236
Sabayan B, Oleksik AM, Maier AB, van Buchem MA, Poortvliet RK, de Ruijter W, et al. High blood pressure and resilience to physical and cognitive decline in the oldest old: the Leiden 85-plus study. J Am Geriatr Soc. 2012;60:2014–9.
doi: 10.1111/j.1532-5415.2012.04203.x
Benetos A, Petrovic M, Strandberg T. Hypertension management in older and frail older patients. Circ Res. 2019;124:1045–60.
doi: 10.1161/CIRCRESAHA.118.313236
Santos-Eggimann B, Karmaniola A, Seematter-Bagnoud L, Spagnoli J, Bula C, Cornuz J, et al. The Lausanne cohort Lc65+: a population-based prospective study of the manifestations, determinants and outcomes of frailty. BMC Geriatr. 2008;8:20.
doi: 10.1186/1471-2318-8-20
Ville de Lausanne. Contrôle des habitants. http://www.lausanne.ch/lausanne-officielle/administration/securite-et-economie/controle-des-habitants.html . Accessed 28 June 2019.
The Lc65+ cohort. Sampling. https://lc65plus.iumsp.ch/en/content/sampling . Accessed 8 April 2019.
Anker D, Santos-Eggimann B, Zwahlen M, Santschi V, Rodondi N, Wolfson C, et al. Blood pressure in relation to frailty in older adults: a population-based study. J Clin Hypertens. 2019;21:1895–1904.
El Assaad MA, Topouchian JA, Darne BM, Asmar RG. Validation of the Omron HEM-907 device for blood pressure measurement. Blood Press Monit. 2002;7:237–41.
doi: 10.1097/00126097-200208000-00006
White WB, Anwar YA. Evaluation of the overall efficacy of the Omron office digital blood pressure HEM-907 monitor in adults. Blood Press Monit. 2001;6:107–10.
doi: 10.1097/00126097-200104000-00007
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146–56.
doi: 10.1093/gerona/56.3.M146
Johnston MC, Crilly M, Black C, Prescott GJ, Mercer SW. Defining and measuring multimorbidity: a systematic review of systematic reviews. Eur J Public Health. 2019;29:182–9.
doi: 10.1093/eurpub/cky098
Benetos A, Rossignol P, Cherubini A, Joly L, Grodzicki T, Rajkumar C, et al. Polypharmacy in the aging patient: management of hypertension in octogenarians. JAMA. 2015;314:170–80.
doi: 10.1001/jama.2015.7517
Danon-Hersch N, Marques-Vidal P, Bovet P, Chiolero A, Paccaud F, Pecoud A, et al. Prevalence, awareness, treatment and control of high blood pressure in a Swiss city general population: the CoLaus study. Eur J Cardiovasc Prev Rehabilit. 2009;16:66–72.
doi: 10.1097/HJR.0b013e32831e9511
Brindel P, Hanon O, Dartigues JF, Ritchie K, Lacombe JM, Ducimetiere P, et al. Prevalence, awareness, treatment, and control of hypertension in the elderly: the Three City study. J Hypertens. 2006;24:51–8.
doi: 10.1097/01.hjh.0000198028.84353.86
Gordis L. Epidemiology. 5th ed. Philadelphia, PA: Elsevier Saunders; 2013. p. 416.
Brummett BH, Babyak MA, Siegler IC, Shanahan M, Harris KM, Elder GH, et al. Systolic blood pressure, socioeconomic status, and biobehavioral risk factors in a nationally representative US young adult sample. Hypertension. 2011;58:161–6.
doi: 10.1161/HYPERTENSIONAHA.111.171272
Marmot M, Bell R. Fair society, healthy lives. Public Health. 2012;126:S4–10.
doi: 10.1016/j.puhe.2012.05.014
Moore MN, Atkins ER, Salam A, Callisaya ML, Hare JL, Marwick TH, et al. Regression to the mean of repeated ambulatory blood pressure monitoring in five studies. J Hypertens. 2019;37:24–9.
doi: 10.1097/HJH.0000000000001977
Chiolero A, Anker D. Screening interval: a public health blind spot. Lancet Public Health. 2019;4:e171–2.
doi: 10.1016/S2468-2667(19)30041-6
Bress AP, Muntner P, Moran AE. Response by Bress et al. to Letters Regarding Article, “Potential Cardiovascular Disease Events Prevented With Adoption of the 2017 American College of Cardiology/American Heart Association Blood Pressure Guideline”. Circulation. 2019;139:e1023–4.
pubmed: 31157999
Olsen MH, Angell SY, Asma S, Boutouyrie P, Burger D, Chirinos JA, et al. A call to action and a lifecourse strategy to address the global burden of raised blood pressure on current and future generations: the Lancet Commission on hypertension. Lancet. 2016;388:2665–712.
doi: 10.1016/S0140-6736(16)31134-5
Moynihan RN, Clark J, Albarqouni L. Media Coverage of the benefits and harms of the 2017 expanded definition of high blood pressure. JAMA Intern Med. 2019;179:272–3.
doi: 10.1001/jamainternmed.2018.6201
Bell KJL, Doust J, Glasziou P. Incremental benefits and harms of the 2017 American College of Cardiology/American Heart Association High Blood Pressure Guideline. JAMA Intern Med. 2018;178:755–7.
doi: 10.1001/jamainternmed.2018.0310
Flack JM, Calhoun D, Schiffrin EL. The new ACC/AHA hypertension guidelines for the prevention, detection, evaluation, and management of high blood pressure in adults. Am J Hypertens. 2018;31:133–5.
doi: 10.1093/ajh/hpx207
Messerli FH, Bangalore S. The blood pressure landscape: schism among guidelines, confusion among physicians, and anxiety among patients. J Am Coll Cardiol. 2018;72:1313–6.
doi: 10.1016/j.jacc.2018.07.026