Long-term absolute benefit of lowering blood pressure in hypertensive patients according to the JNC VI risk stratification

Citation
Lg. Ogden et al., Long-term absolute benefit of lowering blood pressure in hypertensive patients according to the JNC VI risk stratification, HYPERTENSIO, 35(2), 2000, pp. 539-543
Citations number
23
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Journal title
HYPERTENSION
ISSN journal
0194911X → ACNP
Volume
35
Issue
2
Year of publication
2000
Pages
539 - 543
Database
ISI
SICI code
0194-911X(200002)35:2<539:LABOLB>2.0.ZU;2-1
Abstract
Blood pressure (BP) levels alone have been traditionally used to make treat ment decisions in patients with hypertension. The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) recently recommended that risk strata, in addi tion to BP levels, be considered in the treatment of hypertension. We estim ated the absolute benefit associated with a 12 mm Hg reduction in systolic BP over 10 years according to the risk stratification system of JNC VI usin g data from the National Health and Nutrition Examination Survey Epidemiolo gic Follow-up Study. The number-needed-to-treat to prevent a cardiovascular event/death or a death from all causes was reduced with increasing levels of baseline BP in each of the risk strata. In addition, the number-needed-t o-treat was much smaller in persons with greater than or equal to 1 additio nal major risk factor for cardiovascular disease (risk group B) and in thos e with a history of cardiovascular disease or target organ damage (risk gro up C) than in those without additional major risk factors for cardiovascula r disease (risk group A). Specifically, the number-needed-to-treat to preve nt a death from all causes in patients with a high-normal BP, stage 1 hyper tension, or stage 2 or 3 hypertension was, respectively, 81, 60, and 23 for those in risk group A; 19, 16, and 9 for those in risk group B; and 14, 12 , and 9 for those in risk group C. Our analysis indicated that the absolute benefits of antihypertensive therapy depended on BP as well as the presenc e or absence of additional cardiovascular disease risk factors and the pres ence or absence of preexisting clinical cardiovascular disease or target or gan damage.