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Reducing the Blood Pressure-Related Burden of Cardiovascular Disease: Impact of Achievable Improvements in Blood Pressure Prevention and Control.

TitleReducing the Blood Pressure-Related Burden of Cardiovascular Disease: Impact of Achievable Improvements in Blood Pressure Prevention and Control.
Publication TypeJournal Article
Year of Publication2015
AuthorsHardy ST, Loehr LR, Butler KR, Chakladar S, Chang PP, Folsom AR, Heiss G, Maclehose RF, Matsushita K
Secondary AuthorsAvery CL
JournalJ Am Heart Assoc
Volume4
Issue10
Paginatione002276
Date Published2015 Oct 27
ISSN2047-9980
KeywordsAfrican Americans, Antihypertensive Agents, Blood Pressure, Coronary Disease, European Continental Ancestry Group, Female, Heart Failure, Humans, Hypertension, Incidence, Linear Models, Male, Middle Aged, Multivariate Analysis, Prevalence, Preventive Health Services, Prospective Studies, Protective Factors, Risk Assessment, Risk Factors, Stroke, Time Factors, Treatment Outcome, United States
Abstract

BACKGROUND: US blood pressure reduction policies are largely restricted to hypertensive populations and associated benefits are often estimated based on unrealistic interventions.

METHODS AND RESULTS: We used multivariable linear regression to estimate incidence rate differences contrasting the impact of 2 pragmatic hypothetical interventions to reduce coronary heart disease, stroke, and heart failure (HF) incidence: (1) a population-wide intervention that reduced systolic blood pressure by 1 mm Hg and (2) targeted interventions that reduced the prevalence of unaware, untreated, or uncontrolled blood pressure above goal (per Eighth Joint National Committee treatment thresholds) by 10%. In the Atherosclerosis Risk in Communities Study (n=15 744; 45 to 64 years at baseline, 1987-1989), incident coronary heart disease and stroke were adjudicated by physician panels. Incident HF was defined as the first hospitalization with discharge diagnosis code of "428." A 10% proportional reduction in unaware, untreated, or uncontrolled blood pressure above goal resulted in ≈4.61, 3.55, and 11.01 fewer HF events per 100,000 person-years in African Americans, and 3.77, 1.63, and 4.44 fewer HF events per 100 000 person-years, respectively, in whites. In contrast, a 1 mm Hg population-wide systolic blood pressure reduction was associated with 20.3 and 13.3 fewer HF events per 100 000 person-years in African Americans and whites, respectively. Estimated event reductions for coronary heart disease and stroke were smaller than for HF, but followed a similar pattern for both population-wide and targeted interventions.

CONCLUSIONS: Modest population-wide shifts in systolic blood pressure could have a substantial impact on cardiovascular disease incidence and should be developed in parallel with interventions targeting populations with blood pressure above goal.

DOI10.1161/JAHA.115.002276
Alternate JournalJ Am Heart Assoc
PubMed ID26508742
PubMed Central IDPMC4845128
Grant ListHHSN268201100009C / HL / NHLBI NIH HHS / United States
HHSN268201100007C / HL / NHLBI NIH HHS / United States
HHSN268201100011C / HL / NHLBI NIH HHS / United States
R00HL098458 / HL / NHLBI NIH HHS / United States
T32 HL007055 / HL / NHLBI NIH HHS / United States
HHSN268201100006C / HL / NHLBI NIH HHS / United States
P2C HD050924 / HD / NICHD NIH HHS / United States
R00 HL098458 / HL / NHLBI NIH HHS / United States
F32 AR059469 / AR / NIAMS NIH HHS / United States
HHSN268201100012C / HL / NHLBI NIH HHS / United States
T32 DK007750 / DK / NIDDK NIH HHS / United States
HHSN268201100005C / HL / NHLBI NIH HHS / United States
HHSN268201100010C / HL / NHLBI NIH HHS / United States
HHSN268201100008C / HL / NHLBI NIH HHS / United States