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Original Article

Blood Pressure Targets and Absolute Cardiovascular Risk

Ayodele Odutayo, Kazem Rahimi, Allan J. Hsiao, Connor A. Emdin
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https://doi.org/10.1161/HYPERTENSIONAHA.114.04997
Hypertension. 2015;HYPERTENSIONAHA.114.04997
Originally published June 8, 2015
Ayodele Odutayo
From the Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (A.O.); and Nuffield Department of Population Health, George Institute for Global Health (K.R., C.A.E.) and Department of Economics (A.J.H.), University of Oxford, Oxford, United Kingdom.
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Kazem Rahimi
From the Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (A.O.); and Nuffield Department of Population Health, George Institute for Global Health (K.R., C.A.E.) and Department of Economics (A.J.H.), University of Oxford, Oxford, United Kingdom.
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Allan J. Hsiao
From the Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (A.O.); and Nuffield Department of Population Health, George Institute for Global Health (K.R., C.A.E.) and Department of Economics (A.J.H.), University of Oxford, Oxford, United Kingdom.
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Connor A. Emdin
From the Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (A.O.); and Nuffield Department of Population Health, George Institute for Global Health (K.R., C.A.E.) and Department of Economics (A.J.H.), University of Oxford, Oxford, United Kingdom.
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Abstract

In the Eighth Joint National Committee guideline on hypertension, the threshold for the initiation of blood pressure–lowering treatment for elderly adults (≥60 years) without chronic kidney disease or diabetes mellitus was raised from 140/90 mm Hg to 150/90 mm Hg. However, the committee was not unanimous in this decision, particularly because a large proportion of adults ≥60 years may be at high cardiovascular risk. On the basis of Eighth Joint National Committee guideline, we sought to determine the absolute 10-year risk of cardiovascular disease among these adults through analyzing the National Health and Nutrition Examination Survey (2005–2012). The primary outcome measure was the proportion of adults who were at ≥20% predicted absolute cardiovascular risk and above goals for the Seventh Joint National Committee guideline but reclassified as at target under the Eighth Joint National Committee guideline (reclassified). The Framingham General Cardiovascular Disease Risk Score was used. From 2005 to 2012, the surveys included 12 963 adults aged 30 to 74 years with blood pressure measurements, of which 914 were reclassified based on the guideline. Among individuals reclassified as not in need of additional treatment, the proportion of adults 60 to 74 years without chronic kidney disease or diabetes mellitus at ≥20% absolute risk was 44.8%. This corresponds to 0.8 million adults. The proportion at high cardiovascular risk remained sizable among adults who were not receiving blood pressure–lowering treatment. Taken together, a sizable proportion of reclassified adults 60 to 74 years without chronic kidney disease or diabetes mellitus was at ≥20% absolute cardiovascular risk.

  • aged
  • epidemiology
  • hypertension
  • Received December 1, 2014.
  • Revision received December 22, 2014.
  • Accepted April 22, 2015.
  • © 2015 American Heart Association, Inc.
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    Blood Pressure Targets and Absolute Cardiovascular Risk
    Ayodele Odutayo, Kazem Rahimi, Allan J. Hsiao and Connor A. Emdin
    Hypertension. 2015;HYPERTENSIONAHA.114.04997, originally published June 8, 2015
    https://doi.org/10.1161/HYPERTENSIONAHA.114.04997

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    Blood Pressure Targets and Absolute Cardiovascular Risk
    Ayodele Odutayo, Kazem Rahimi, Allan J. Hsiao and Connor A. Emdin
    Hypertension. 2015;HYPERTENSIONAHA.114.04997, originally published June 8, 2015
    https://doi.org/10.1161/HYPERTENSIONAHA.114.04997
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