Abstract 18774: Impact of the 2014 Expert Panel Recommendations for Management of High Blood Pressure on Contemporary Cardiovascular Practice: Insights from the NCDR® PINNACLE Registry®
Background: Since 2003, the Seventh Report of the Joint National Committee (JNC 7) has been the predominant guideline for blood pressure management. A 2014 expert panel recommended increasing the blood pressure targets for patients aged 60 and older as well as those with diabetes or chronic kidney disease. We sought to examine the impact of the 2014 expert panel blood pressure management recommendations on patients managed in U.S. ambulatory cardiovascular practices.
Methods: Using the NCDR® PINNACLE Registry®, a national voluntary quality improvement data registry of cardiology outpatient practices, we assessed the proportion of patients who met the 2003 JNC 7 and 2014 panel recommendations, highlighting the populations of patients for whom the blood pressure goals changed.
Results: Of 1,185,253 patients with hypertension in the study cohort, 706,859 (59.6%) achieved 2003 JNC 7 blood pressure goals. Using the 2014 recommendations, those at goal rose to 880,378 (74.3%) (Figure). Among the 173,519 (14.6%) for whom goal achievement status changed, 112,174 (64.6%) had coronary artery disease, and 40,323 (23.2%) had a prior stroke or transient ischemic attack. The average Framingham risk score in this group was 8.5% (standard deviation [SD] ±3.2%), and the 10-year ASCVD risk score was 28.0% (SD ±19.5%). By comparison, the patients meeting the 2003 JNC 7 goals and the 2014 panel report goals had average Framingham risk scores of 4.8% (±4.0%) and 5.5% (±4.2%) and 10-year ASCVD risk scores of 18.6% (±16.8%) and 20.6% (±17.8%), respectively
Conclusions: Among U.S. ambulatory cardiology patients with hypertension, nearly one in seven who did not meet JNC 7 recommendations would now meet the 2014 treatment goals. Many patients for whom the target blood pressure is now more permissive are at high cardiovascular risk. If the new recommendations are implemented in clinical practice, blood pressure target achievement and cardiovascular events will need careful monitoring.
Author Disclosures: W.B. Borden: None. T.M. Maddox: None. F. Tang: None. J.S. Rumsfeld: None. W.J. Oetgen: None. J.B. Mullen: None. S.A. Spinler: None. E. Peterson: None. F.A. Masoudi: None.
- © 2014 by American Heart Association, Inc.