Goal BP control in 2018

ACC/AHA

2017: 140/90 mmHg for HTN with 10 year CVD risk score >= 10%.

2018: 130/80 mmHg for every person with HTN based on office measurement (new definition of hypertension).

-------------------------------------------------------------

SPRINT (systolic blood pressure intervention trial) modified by CVD risk score

Benefit-to-Harm Ratio as:

1st quartile (< 11.5%)=0.5;

2nd quartile (11.5%-18.1%) = 0.78;

3rd quartile (18.2%-28.9%) = 2.13;

4th quartile (>28.9%) = 4.8

---> agressive BP control (office SBP<130 mmHg) in hypertensive patients with CVD risk score >= 18.2%

 

97.1% of those >= 75 yo in SPRINT study were high risk >18.2%, benefits likely outweigh harms.

 

Benefits include: cardiovascular mortality, acute decompensated heart failure admissions.

Harms include: hypotension, syncope, bradycardia, electrolyte abnormality, injurious falls, acute kidney injury or acute renal failure.

 

Ref: JACC 2018, 71,15:1601-10.