Population impact of different hypertension management guidelines based on the prospective population-based Heinz Nixdorf Recall study
Objective Hypertension guidelines strongly differ between societies. The current American College of Cardiology/American Heart Association (ACC/AHA) guideline recommends higher proportions of the general population for antihypertensive medication than the previous American and European guidelines. H...
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BMJ Publishing Group
2021-02-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/11/2/e039597.full |
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| author | Susanne Moebus Karl-Heinz Jöckel Andreas Stang Janine Gronewold Rene Kropp Nils Lehmann Raimund Erbel Dirk M Hermann Martin Dichgans Christian Weimar Knut Kröger Barbara Hoffmann Amir A Mahabadi |
| author_facet | Susanne Moebus Karl-Heinz Jöckel Andreas Stang Janine Gronewold Rene Kropp Nils Lehmann Raimund Erbel Dirk M Hermann Martin Dichgans Christian Weimar Knut Kröger Barbara Hoffmann Amir A Mahabadi |
| author_sort | Susanne Moebus |
| collection | DOAJ |
| description | Objective Hypertension guidelines strongly differ between societies. The current American College of Cardiology/American Heart Association (ACC/AHA) guideline recommends higher proportions of the general population for antihypertensive medication than the previous American and European guidelines. How cardiovascular risk differs between persons with and without antihypertensive medication recommendation has not been examined. Additionally, the population impact of American, European and international guidelines has not been compared systematically within the same study population.Methods We compared the prevalence of antihypertensive medication recommendation according to the American (Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 7 (JNC7), ACC/AHA 2017), European (European Society of Hypertension (ESH)/European Society of Cardiology (ESC) 2013/2018), and international (WHO/International Society of Hypertension (ISH) 2003, ISH 2020) guidelines in 3092 participants of the population-based Heinz Nixdorf Recall study not taking antihypertensive medication at the baseline examination (58.1±7.5 years, 48.7% males). We furthermore compared incident cardiovascular events during the 5-year follow-up between participants with and without antihypertensive medication recommendation.Results The ACC/AHA 2017 guideline recommended the highest percentage of participants for antihypertensive medication (45.8%) compared with the JNC7 (37.2%), ESH/ESC 2013 (17.8%), ESC/ESH 2018 (26.7%), WHO/ISH 2003 (20.3%) or ISH 2020 (25.0%) guidelines. Participants with antihypertensive medication recommendation according to the ACC/AHA 2017 guideline had a significantly higher incidence of cardiovascular events during the 5-year follow-up compared with participants without this recommendation (2.5% vs 1.1%, p=0.003).Conclusions Our results call for randomised controlled trials to investigate whether applying the stricter ACC/AHA 2017 recommendation leads to a reduction in cardiovascular disease. |
| format | Article |
| id | doaj-art-92ac2b91d7d5452bb958a1411e1c27fb |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2021-02-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-92ac2b91d7d5452bb958a1411e1c27fb2025-08-20T02:11:25ZengBMJ Publishing GroupBMJ Open2044-60552021-02-0111210.1136/bmjopen-2020-039597Population impact of different hypertension management guidelines based on the prospective population-based Heinz Nixdorf Recall studySusanne Moebus0Karl-Heinz Jöckel1Andreas Stang2Janine Gronewold3Rene Kropp4Nils Lehmann5Raimund Erbel6Dirk M Hermann7Martin Dichgans8Christian Weimar9Knut Kröger10Barbara Hoffmann11Amir A Mahabadi12Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, GermanyInstitute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, GermanyInstitute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, GermanyDepartment of Neurology, University Hospital Essen, Essen, GermanyDepartment of Neurology, University Hospital Essen, Essen, GermanyInstitute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, GermanyInstitute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, GermanyDepartment of Neurology, University Hospital Essen, Essen, GermanyInstitute for Stroke and Dementia Research, University Hospital, Ludwig-Maximilians-Universität LMU, Munich, GermanyDepartment of Neurology, University Hospital Essen, Essen, GermanyDepartment of Angiology, Helios-Klinikum Krefeld, Krefeld, GermanyprofessorWest German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Essen, GermanyObjective Hypertension guidelines strongly differ between societies. The current American College of Cardiology/American Heart Association (ACC/AHA) guideline recommends higher proportions of the general population for antihypertensive medication than the previous American and European guidelines. How cardiovascular risk differs between persons with and without antihypertensive medication recommendation has not been examined. Additionally, the population impact of American, European and international guidelines has not been compared systematically within the same study population.Methods We compared the prevalence of antihypertensive medication recommendation according to the American (Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 7 (JNC7), ACC/AHA 2017), European (European Society of Hypertension (ESH)/European Society of Cardiology (ESC) 2013/2018), and international (WHO/International Society of Hypertension (ISH) 2003, ISH 2020) guidelines in 3092 participants of the population-based Heinz Nixdorf Recall study not taking antihypertensive medication at the baseline examination (58.1±7.5 years, 48.7% males). We furthermore compared incident cardiovascular events during the 5-year follow-up between participants with and without antihypertensive medication recommendation.Results The ACC/AHA 2017 guideline recommended the highest percentage of participants for antihypertensive medication (45.8%) compared with the JNC7 (37.2%), ESH/ESC 2013 (17.8%), ESC/ESH 2018 (26.7%), WHO/ISH 2003 (20.3%) or ISH 2020 (25.0%) guidelines. Participants with antihypertensive medication recommendation according to the ACC/AHA 2017 guideline had a significantly higher incidence of cardiovascular events during the 5-year follow-up compared with participants without this recommendation (2.5% vs 1.1%, p=0.003).Conclusions Our results call for randomised controlled trials to investigate whether applying the stricter ACC/AHA 2017 recommendation leads to a reduction in cardiovascular disease.https://bmjopen.bmj.com/content/11/2/e039597.full |
| spellingShingle | Susanne Moebus Karl-Heinz Jöckel Andreas Stang Janine Gronewold Rene Kropp Nils Lehmann Raimund Erbel Dirk M Hermann Martin Dichgans Christian Weimar Knut Kröger Barbara Hoffmann Amir A Mahabadi Population impact of different hypertension management guidelines based on the prospective population-based Heinz Nixdorf Recall study BMJ Open |
| title | Population impact of different hypertension management guidelines based on the prospective population-based Heinz Nixdorf Recall study |
| title_full | Population impact of different hypertension management guidelines based on the prospective population-based Heinz Nixdorf Recall study |
| title_fullStr | Population impact of different hypertension management guidelines based on the prospective population-based Heinz Nixdorf Recall study |
| title_full_unstemmed | Population impact of different hypertension management guidelines based on the prospective population-based Heinz Nixdorf Recall study |
| title_short | Population impact of different hypertension management guidelines based on the prospective population-based Heinz Nixdorf Recall study |
| title_sort | population impact of different hypertension management guidelines based on the prospective population based heinz nixdorf recall study |
| url | https://bmjopen.bmj.com/content/11/2/e039597.full |
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