NEW YORK (Reuters Health) – The number of Canadians diagnosed with hypertension could increase by as much as 14% with the eligibility criteria from the Systolic Blood Pressure Intervention Trial (SPRINT) or the 2017 American College of Cardiology/American Heart Association (ACC/AHA) high blood pressure guidelines, researchers report.
“A shift towards lowering blood pressure targets for people with hypertension will affect over a million Canadian adults,” Dr. Alexander A. Leung from the University of Calgary, Canada, told Reuters Health by email. “Such a change would have far-reaching implications on healthcare resource utilization, public policy, and healthcare delivery.”
“Lower blood pressure targets are expected to reduce the risk of heart disease and death in a large number of patients treated for hypertension,” he said. “However, lower treatment targets will also entail more physician visits, greater medication use, and will also potentially lead to a higher rate of side effects from medications.”
These conclusions follow an analysis in which Dr. Leung and colleagues explored the potential impact of applying SPRINT eligibility criteria (age 50 years or older, systolic blood pressure 130 mmHg or higher and high risk for cardiovascular disease) to the Canadian population.
Approximately 1.3 million people (5.2%) adults met all these criteria, but only about 59% of these had treated hypertension, the researchers report in the Canadian Journal of Cardiology, online May 4.
More than 14% of these individuals were not previously considered to have hypertension or to need antihypertensive therapy, and 18.7% of those already treated for hypertension would qualify for further treatment intensification.
“Hypertension Canada’s clinical practice guidelines now recommend a lower systolic blood pressure target of <120 mmHg (compared to <140 mmHg) in certain people at increased risk for heart disease aged 50 years or older, but without diabetes or stroke,” Dr. Leung said. “These recommendations have the potential of affecting a large number of Canadians. Physicians should be prepared to speak to their patients about the potential benefits of treatment to a lower blood pressure target.”
In a related study, Dr. Remi Goupil from Hopital du Sacre-Coeur de Montreal, Canada, and colleagues evaluated the potential Canadian effects of applying the 2017 ACC/AHA hypertension guidelines versus the 2017 Hypertension Canada (HC) guidelines.
Application of the ACC/AHA guidelines (which define hypertension as blood pressures of 130/80 mmHg and higher) instead of the HC guidelines (which have this threshold for patients with diabetes and a higher threshold, 180/110 mmHg, for everyone else) would increase hypertension diagnoses by 8.7%.
Differences in the thresholds for antihypertensive treatment would translate into 3.4% more individuals needing treatment and 17.2% having different blood pressure targets with the ACC/AHA guidelines.
“While all guidelines differ to some extent, it is important to remember that they provide broad recommendations aimed at the population level,” Dr. Goupil told Reuters Health by email. “In other words, these recommendations are not made to be applicable for every single patient. Individualization of care and patient preferences must remain high priorities in all treatment decisions.”
“Shifts in definitions of highly prevalent chronic diseases, such as hypertension, can have dramatic socioeconomic impacts in a country,” he said. “Therefore, it is important to consider the basis and motivations under the proposed changes, and decide whether they apply to the Canadian population. In this regard, the Hypertension Canada expert panel has published its latest guidelines in the same issue as our article and chose not to retain the conclusions of its American counterpart.”
Dr. Ross D. Feldman from the University of Manitoba, in Winnipeg, Canada, who wrote an accompanying editorial, told Reuters Health by email, “With SPRINT we have solid data to support more aggressive targets in blood pressure treatment, which on a public health basis can translate into big numbers of lives saved (but requires more vigilance to avoid the increased risk of complications).”
“I still maintain that the real challenge and the main barrier to achieving this extent of life-saving in the U.S. has been the relative ineffectiveness in their adoption by U.S. health care providers,” he said.
Dr. Ernesto L. Schiffrin from Sir Mortimer B. Davis-Jewish General Hospital, McGill University, in Montreal, who has also reviewed the potential impact of the 2017 ACC/AHA guidelines in Canada but was not involved in the new research, said their adoption would “necessarily mean an increase in the cost of hypertension care, but if the SPRINT results are indeed applicable to Canada, admission to hospital for heart failure will be reduced, and healthcare costs will be reduced, and life will be extended for many individuals benefiting from intensified treatment.”
“If the benefits of SPRINT are to be conferred on Canadian patients, initiating treatment at lower thresholds and intensifying treatment for higher risk hypertensive patients will need to be considered by physicians, in other words, following the Hypertension Canada guidelines, which have a SPRINT-based recommendation for high-risk SPRINT-like patients,” he told Reuters Health by email.
SOURCE: https://bit.ly/2rywogQ, https://bit.ly/2wCGMKC and https://bit.ly/2I64h3L
Can J Cardiol 2018.
Tidak ada komentar:
Posting Komentar