Article
Cardiovascular risk in persons with antihypertensive medication recommendation based on recent and previous American, European and international arterial hypertension guidelines in the German general population
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Published: | September 6, 2019 |
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Background: Arterial hypertension guidelines strongly differ between societies. The recommendation for antihypertensive treatment of the current American College of Cardiology/American Heart Association (ACC/AHA) guideline are wider than of previous and recent American, European and international guidelines. How cardiovascular risk differs between persons with and without antihypertensive medication recommendation has not been examined for different guidelines.
Methods: In the population-based Heinz Nixdorf Recall study comprising 4814 participants aged 45-75 years, we compared the prevalence of antihypertensive medication recommendation according to American (Joint National Committee 7 [JNC7], ACC/AHA 2017), European (European Society of Hypertension [ESH]/European Society of Cardiology [ESC] 2013/2018), and World Health Organization (WHO) 2003 guidelines. We furthermore compared prevalence and progression of subclinical atherosclerosis, assessed by baseline coronary artery calcification (CAC) and rapid CAC progression during 5-year follow-up, as well as incident cardiovascular events during 5-year follow-up between participants with and without antihypertensive medication recommendation.
Results: ACC/AHA 2017 recommended the highest percentage of participants that hitherto did not take antihypertensive medication for antihypertensive medication (45.8%) compared to JNC7 (37.2%), ESH/ESC 2013 (17.8%), ESC/ESH 2018 (26.7%) or WHO (20.3%) guidelines. The recommendation to receive vs. not receive antihypertensive medication discriminated cardiovascular events during 5-year follow-up better using ACC/AHA 2017 (2.5% vs. 1.1%, p=0.003) than other guidelines. Baseline CAC (median:31.4[Q1;Q3:1.0;173.9] vs. 1.3[0.0;30.6], p<0.001), but not rapid CAC progression during 5-year follow-up (19.5% vs. 17.9%, p=0.310) was increased in participants with vs. without antihypertensive medication recommendation.
Conclusions: Although its antihypertensive medication recommendation is widest, ACC/AHA 2017 discriminated cardiovascular risk better than the other guidelines.
The authors declare that they have no competing interests.
The authors declare that a positive ethics committee vote has been obtained.