Clinical application and potential effects of 2014 hypertension guidelines on incident cardiovascular events

• Published in: The American heart journal 2015-11, Vol.170 (5), p.1042-1049.e5
• Main Authors: Ko, Min Jung, PhD, Park, Chan Mi, PhD, Kim, Yun Jung, MPH, Kang, Shin Hee, PhD, Park, Duk-Woo, MD, PhD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Antihypertensive Agents - therapeutic use; Blood Pressure - physiology; Body mass index; Cardiovascular; Cardiovascular disease; Cross-Sectional Studies; Diabetes; Disease prevention; Female; Guideline Adherence; Health risk assessment; Heart attacks; Humans; Hypertension; Hypertension - drug therapy; Hypertension - epidemiology; Incidence; Institutionalization; Kidney diseases; Laboratories; Male; Middle Aged; Population; Population Surveillance; Republic of Korea - epidemiology; Retrospective Studies; Risk Factors; Young Adult
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2015.07.028

Background The applicability to real-world hypertensive patients and the potential effects on future cardiovascular events of the 2014 hypertension guidelines of the Eighth Joint National Committee (JNC-8) remain to be determined. Methods Using the Korean National Health and Nutrition Examination Survey of 2008 to 2012 (n = 30,697), we estimated the proportion of Korean adults eligible for hypertension therapy under the 2014 JNC-8 and previous JNC-7 guidelines and the changes affected by the 2014 guidelines. Using the validation cohort (n = 116,767) from the 2003 National Health Examination with 7 years of follow-up, we determined the clinical effects of recent recommendations changes on incident cardiovascular events (composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke). Results Compared with the JNC-7 guidelines, the 2014 guidelines would decrease the number of adults eligible for hypertension therapy from 10.1 million (28.2%) to 9.3 million (25.9%). In the validation cohort, compared with nonhypertensive adults, those eligible for hypertension therapy under the JNC-7 or JNC-8 guidelines had significantly higher risks of cardiovascular events (hazard ratio [HR], 5.05; 95% confidence interval [CI], 4.58-5.57, P < 0.001; and HR, 5.11; 95% CI, 4.63-5.64, P < 0.001, respectively). In addition, adults newly ineligible for treatment under the 2014 guidelines had an increased risk of cardiovascular events relative to nonhypertensive adults (HR, 4.36; 95% CI, 3.65-5.20; P < 0.001). Conclusions The 2014 hypertension guidelines would modestly decrease the proportion of Korean adults eligible for hypertension therapy. Adults newly ineligible for hypertension therapy by the 2014 guidelines have a higher risk of cardiovascular events compared to nonhypertensive adults. Our observations should be confirmed or refuted through large, randomized clinical trials.