Table 6.
Simulation study by Bundy et al.100 comparing estimated annual prevention of CVD events and deaths by adhering to 2014 JNC-8 panel recommendations or the 2017 ACC/AHA BP Guideline.
| Basis for Estimation | |
| (1) | Estimation of proportion of US adults in BP categories using NHANES |
| (2) | Incidence of major CVD events & all-cause mortality by modeling 4 large community-based cohort studies (ARCS, CV Health, Framingham, MESA) |
| (3) | Network meta-analysis (42 RCTs) to estimate HRs for outcomes and determine population-attributable risks and events reduced. |
| Characteristic | 2014 Evidence-Based Guideline | 2017 ACC/AHA Guideline |
|---|---|---|
| BP threshold (mm Hg) for initiation of antihypertensive drugs | ≥140/90 (<age 60) ≥150/90 (≥age 60) |
≥140/90 (gen. population) ≥130/80 (high CVD risk) |
| BP goal (mm Hg) of treatment | <140/90 (<age 60) <150/90 (≥age 60) |
<130/80 |
| Annual CVD event reduction (≥age 40) | 270,000 | 610,000 (NNT=70) |
| Annual reduction in death (≥age 40) | 177,000 | 334,000 (NNT=129) |
Note: Sensitivity analysis determined that, even if 100% implementation of the 2017 guideline were not achieved, the CVD event and death reductions would still be significantly larger compared to the 2014 guideline. ACC, American College of Cardiology; AHA, American Heart Association; ARCS, Atherosclerosis Risk in Communities Study, BP, blood pressure; CV, cardiovascular; CVD, cardiovascular disease; JNC, Joint National Committee; MESA, Multi-Ethnic Study of Atherosclerosis Study; NHANES, National Health and Nutrition Examination Survey; NNT, number needed to treat; RCT, randomized controlled trial.