In 2017, the American College of Cardiology and the American Heart Association released new blood pressure guidelines, lowering hypertension threshold to 130/80 mm Hg from the previous 140/90 mm Hg.

A new study predicts that achieving and maintaining the 2017 guideline blood pressure goals could prevent more than 3 million cardiovascular disease events over ten years. The results of the study will appear online in the November 19 issue of Circulation.

"Treating high blood pressure is a major public health opportunity to protect health and quality of life for tens of millions of Americans," said the study's lead author Adam Bress, Pharm.D., assistant professor in Population Health Sciences at the University of Utah Health. "Achieving these lower goals will be challenging."

Guideline recommendations

Bress and his team wanted to explore the impact of achieving and maintaining the lower guideline-recommendations on the public compared to earlier blood pressure and treatment levels, as well as patients' ability to achieve and maintain earlier guideline recommendations.

The team predicted the number of cardiovascular events averted in middle-age adults based on the blood pressure goals of the 2017 blood pressure guidelines (< 130/80 mm Hg), the seventh Joint National Committee (JNC7) guidelines (< 140/90 mm Hg) and the Eighth Joint National Committee (JNC8) guidelines (140/90 mg Hg for patients younger than 60 and 150/90 mm Hg for patients older than 60).

Their analysis projects 3.3 million fewer cardiovascular disease events after achieving and maintaining the 2017 blood pressure goals compared to current blood pressure levels. They also found that achieving and maintaining the JNC7 and JNC8 recommended blood pressure goals would prevent 2.6 and 1.6 million cardiovascular disease events, respectively.

This study made these predictions using several contemporary, population-based databases. The NHANES dataset is a nationally representative survey of the U.S. adult population and provides population sizes of hypertension treatment groups by blood pressure levels and chronic conditions.

The REGARDS database provides a source for the risk of fatal and nonfatal cardiovascular events. A recent meta-analysis of 42 randomized blood pressure-lowering clinical trials, consisting of more than 140,000 participants, provides risk reduction predictions for cardiovascular events based on achieving and maintaining different blood pressure treatment targets.

Most cardiovascular disease events prevented came from those with current blood pressure levels above 140/90 mm Hg. Models assumed that patients achieved and maintained blood pressure goals over the course of the simulation.

Previous studies suggest the initial upfront investment for treating more adults for hypertension leads to health gains and cost savings over the lifetime of treatment. But change does not always come easily.