Blood Pressure Guidelines: Is Change Coming?

Using a benefit-based approach instead of a treat-to-target approach in determining how to treat hypertension could help prevent more cardiovascular events with less medication.

A more individualized set of treatment guidelines for prescription of blood pressure—lowering medications could prevent more cardiovascular events while using less medication than is the case with current guidelines, according to the results of a new study.

According to study authors, the current approach, based on blood pressure targets, has led some patients to overuse antihypertensive medications and other patients to underuse the medications. Instead of treating to a target level, the new study advises prescribers to decide which patients are the best candidates for antihypertensive treatment by assessing each patient's cardiovascular risk. The study was published in the November 19, 2013, issue of Circulation.

The researchers used data from the National Health and Nutrition Examination Survey (NHANES) III to determine the effects of a 5-year course of antihypertensive medication in terms of quality-adjusted life-years. The data was representative of 176 million Americans between 30 and 85 years of age with no history of severe congestive heart failure and no history of cardiovascular events (stroke or myocardial infarction).

For more than half of patients (55%), an antihypertensive regimen based on the treat-to-target approach would be identical to the regimen with the benefit-based approach. However, over 5 years, the benefit-based approach reduced medication use by 6% while preventing 900,000 more cardiovascular events and saving 2.8 million more quality-adjusted life years compared with the treat-to-target approach.

In a news release, lead study author Jeremy Sussman, MD, an assistant professor at the University of Michigan Medical School and a research scientist with the Center for Clinical Management Research at the VA Ann Arbor Healthcare System, stated, “We found that people who have mildly high blood pressure but high cardiovascular risk receive a lot of benefit from treatment, but those with low overall cardiovascular risk do not.”

Instead of using blood pressure targets recommended by the current guidelines, the study supports a patient-tailored approach to blood pressure reduction that emphasizes individualized treatment based on patient-specific risks. The release of this study coincides with that of the new lipid control guidelines from the American College of Cardiology (ACC)/American Heart Association (AHA) expert panel. Like the new lipid control guidelines, the study emphasizes the importance of a patient-tailored approach to treating cardiovascular disease. Although the lipid-control guidelines have been met with criticism from some quarters, Dr. Sussman and his fellow researchers have shown that, when it comes to blood pressure control, getting better outcomes with less medication is possible. Changes to hypertension guidelines may arrive soon.