(Hypertension. 2000;35:539.)
© 2000 American Heart Association, Inc.
Scientific Contributions |
Long-Term Absolute Benefit of Lowering Blood Pressure in Hypertensive Patients According to the JNC VI Risk Stratification
From the Departments of Biostatistics (L.G.O.) and Epidemiology (J.H., P.K.W.), Tulane University School of Public Health and Tropical Medicine, New Orleans, La, and SmithKline Beecham Pharmaceuticals (E.L.), Collegeville, Pa.
Correspondence to Jiang He, MD, PhD, Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1430 Tulane Ave SL 18, New Orleans, LA 70112-2699. E-mail jhe{at}mailhost.tcs.tulane.edu
Abstract—Blood pressure (BP)
levels alone have been traditionally used to make treatment decisions
in patients with hypertension. The sixth report of the Joint National
Committee on Prevention, Detection, Evaluation, and Treatment of High
Blood Pressure (JNC VI) recently recommended that risk strata, in
addition to BP levels, be considered in the treatment of hypertension.
We estimated the absolute benefit associated with a 12 mm Hg
reduction in systolic BP over 10 years according to the risk
stratification system of JNC VI using data from the National Health and
Nutrition Examination Survey Epidemiologic Follow-up Study. The
number-needed-to-treat to prevent a cardiovascular
event/death or a death from all causes was reduced with increasing
levels of baseline BP in each of the risk strata. In addition, the
number-needed-to-treat was much smaller in persons with 
1
additional major risk factor for cardiovascular disease
(risk group B) and in those with a history of
cardiovascular disease or target organ damage (risk
group C) than in those without additional major risk factors for
cardiovascular disease (risk group A). Specifically,
the number-needed-to-treat to prevent a death from all causes in
patients with a high-normal BP, stage 1 hypertension, or stage 2 or 3
hypertension was, respectively, 81, 60, and 23 for those in risk group
A; 19, 16, and 9 for those in risk group B; and 14, 12, and 9 for those
in risk group C. Our analysis indicated that the absolute
benefits of antihypertensive therapy depended on BP as well as the
presence or absence of additional cardiovascular
disease risk factors and the presence or absence of preexisting
clinical cardiovascular disease or target organ
damage.
Key Words: blood pressure • cardiovascular diseases • mortality • risk factors
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