ACC/AHA
2017: 140/90 mmHg for HTN with 10 year CVD risk score >= 10%.
2018: 130/80 mmHg for every person with HTN based on office measurement (new definition of hypertension).
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SPRINT (systolic blood pressure intervention trial) modified by CVD risk score
Benefit-to-Harm Ratio as:
1st quartile (
2nd quartile (11.5%-18.1%) = 0.78;
3rd quartile (18.2%-28.9%) = 2.13;
4th quartile (>28.9%) = 4.8
---> agressive BP control (office SBP= 18.2%
97.1% of those >= 75 yo in SPRINT study were high risk >18.2%, benefits likely outweigh harms.
Benefits include: cardiovascular mortality, acute decompensated heart failure admissions.
Harms include: hypotension, syncope, bradycardia, electrolyte abnormality, injurious falls, acute kidney injury or acute renal failure.
Ref: JACC 2018, 71,15:1601-10.
