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Risk-based strategy for BP-lowering may improve on current guidelines
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A CV risk-based strategy for BP-lowering has the potential to prevent more CVD events than previous and current guidelines, while aligning with current lipid-lowering recommendations and retaining comparable efficacy.
According to study results published in The Lancet, using a CV risk-based assessment strategy could prevent more than 33% more events than the 2011 U.K. National Institute for Health and Care Excellence (NICE) guidelines and 20% more events than the current 2019 NICE guidelines.
Cardiology Today corresponded with Emily Herrett, BSc, MSc, PhD, assistant professor at the London School of Hygiene and Tropical Medicine, regarding the implications of these findings.
“Our study estimated that making decisions about blood pressure treatment entirely based on absolute cardiovascular risk, like the one for statins, could prevent one-third more CVD events over the next 10 years compared to current guidance,” Herrett said. “Crucially, treatment would be directed toward patients who would receive the most benefit and avoid over-treating patients with low risk for cardiovascular disease.”
In this retrospective cohort study, which used data from the U.K. Clinical Practice Research Datalink, researchers analyzed the diagnoses, tests, clinical measurements, prescriptions and specialist referrals of more than 1.2 million patients aged 30 to 79 years who were treated at Clinical Practice Research Datalink practices.
Patients were followed for a median of 4.3 years, from January 2011 to March 2016, or until death.
Researchers compared four different strategies to determine eligibility for BP treatment:
- use of the 2011 NICE guideline;
- use of the proposed 2019 NICE guideline;
- BP alone (threshold 140/90 mm Hg); and
- predicted 10-year CV risk alone (QRISK2 score 10%).
For each treatment strategy, researchers estimated the number of patients eligible for treatment, number of potentially preventable CV events and then estimated a 10-year projection of these findings for the general population of the U.K.
“Our study shows the need for re-assessment of the 2011 and proposed 2019 NICE blood pressure treatment guidelines,” the authors wrote. “A cardiovascular risk-based strategy would align with the lipid-lowering guideline and streamline provision of cardiovascular disease prevention, with the potential to prevent more cardiovascular disease and with more efficiency than current guidelines.”
Researchers found that 357,840 patients were eligible for treatment using the QRISK2 threshold of 10%, 481,859 were eligible on the basis of the BP threshold of 140/90 mm Hg or higher, 327,429 under the propose 2019 NICE guideline and 271,963 under the 2011 NICE guideline.
The rate of CV events in patients eligible for each strategy were 16.9 per 1,000 person-years using the QRISK2 threshold only, 15.2 per 1,000 person-years under the 2011 NICE guideline, 14.9 per 1,000 person-years under the proposed 2019 NICE guideline and 11.4 per 1,000 person-years using the BP threshold only.
Projected over the course of the next 10 years and scaled to the U.K. population, researchers estimated that 322,921 CV events could be avoided using the QRISK threshold, 301,523 using the BP threshold alone, 270,233 under the proposed 2019 NICE guideline and 233,152 under the 2011 NICE guideline, according to the findings.
“Given the efficiency of this approach, we feel that guidelines for blood pressure treatment need to be re-assessed,” Herrett told Cardiology Today. “However, it is important to remember that drugs aren’t a silver bullet and if a patient’s risk or blood pressure is high, we need to think about lifestyle changes first before considering drug treatment.” – by Scott Buzby
For more information:
Emily Herrett , BSc, MSc, PhD can be reached at Room 256, LSHTM, Keppel Street, London, WC1E 7HT, United Kingdom; email: emily.herrett@lshtm.ac.uk; Twitter: @emilyherrett
Disclosures: Herrett reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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