Stroke survivors with hypertension who are recommended earlier antihypertensive treatment and lifestyle modification may greatly increase their chances of survival.
2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension recommendations could decrease stroke mortality, according to results published in the Journal of the American Heart Association.1
Using the new, more stringent blood pressure cutoffs for hypertension recommended by 2017 American College of Cardiology (ACC)/American Heart Association (AHA), compared to those recommended by the seventh report of the Joint National Committee (JNC), would result in almost 67% increase in the proportion of stroke survivors with hypertension, and 54% increase in stroke survivors with hypertension not at goal. That means many more stroke survivors with hypertension would be recommended earlier antihypertensive treatment and lifestyle modification. As a result, death from a repeat stroke could decrease by almost 33%.
“The societal gain if the new guidelines were fully implemented would be reflected in the lower stroke recurrence rate, as suggested by prior studies that have found that every reduction of 1 mm Hg of BP was associated with a 4% reduction in stroke recurrence,” wrote first author Alain Lekoubou, MD, MSc, of the Medical University of South Carolina (Charleston, SC), and colleagues. “Our results call for preemptive actions to successfully implement the new guidelines in stroke survivors,” they added.
A large body of evidence has shown that hypertension increases the risk of stroke in a dose response fashion. While hypertension is linked to increased mortality in stroke, research has also shown a decline in stroke mortality over the past several decades, largely due to treatment for hypertension.
But research suggests that stroke risk may increase below these cutoffs. As a result, in 2017 the ACC/AHA lowered the cutoff for hypertension in people at high risk of CV events , including stroke, to ≥130 mmHg systolic and ≥ 80 mmHg diastolic. The ACC/AHA also recommends starting medication in hypertensive stroke survivors, with a blood pressure target of <130/80 mmHg.
To compare the impact of these different cutoffs, researchers used data from the nationally representative National Health and Nutrition Examination Surveys (NHANES) survey. The analysis included 6,250,751 adults (41.6% men) who participated in the 2003-2014 surveys. Blood pressure data came from clinical measurement at office visits. Data on stroke and antihypertensive treatment came from self-report.
• Large analysis of NHANES data suggests using 2017 ACC/AHA cutoffs for hypertension compared to those recommended by JNC7 would result in a substantial increase in the number of stroke survivors with hypertension as well as in those with treated hypertension but not at goal
• Using the 2017 ACC/AHA guidelines would result in an increase in early treatment for hypertension among stroke survivors, and may substantially decrease death from recurrent stroke
• The authors call for action to implement the 2017 ACC/AHA guidelines among stroke survivors.
1. Lekoubou A, Bishu KG, Ovbiagele B, et al. Nationwide Impact of the 2017 American College of Cardiology/American Heart Association Blood Pressure Guidelines on Stroke Survivors. J Am Heart Assoc. 2018 Jun 6;7(12). pii: e008548. doi: 10.1161/JAHA.118.008548.
2. Bress AP, Bellows BK, King JB, et al. Cost-Effectiveness of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2017;377:745-755.
3. Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42:1206–1252
4. Rothwell PM, Howard SC, Dolan E, et al. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet. 2010;375:895-905.
5. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:1269–1324.