Reducing the Blood Pressure-Related Burden of Cardiovascular Disease: Impact of Achievable Improvements in Blood Pressure Prevention and Control

Details

• Personal Author:
  Avery CL ; Butler KR ; Chakladar S ; Chang PP ; Folsom AR ; Hardy ST ; Heiss G ; Loehr LR ; MacLehose RF ; Matsushita K
• Description:
  Background: US blood pressure reduction policies are largely restricted to hypertensive populations and associated benefits are often estimated based on unrealistic interventions. Methods and Results: We used multivariable linear regression to estimate incidence rate differences contrasting the impact of 2 pragmatic hypothetical interventions to reduce coronary heart disease, stroke, and heart failure (HF) incidence: (1) a population-wide intervention that reduced systolic blood pressure by 1 mm Hg and (2) targeted interventions that reduced the prevalence of unaware, untreated, or uncontrolled blood pressure above goal (per Eighth Joint National Committee treatment thresholds) by 10%. In the Atherosclerosis Risk in Communities Study (n=15 744; 45 to 64 years at baseline, 1987-1989), incident coronary heart disease and stroke were adjudicated by physician panels. Incident HF was defined as the first hospitalization with discharge diagnosis code of "428." A 10% proportional reduction in unaware, untreated, or uncontrolled blood pressure above goal resulted in approx. equal to 4.61, 3.55, and 11.01 fewer HF events per 100 000 person-years in African Americans, and 3.77, 1.63, and 4.44 fewer HF events per 100 000 person-years, respectively, in whites. In contrast, a 1 mm Hg population-wide systolic blood pressure reduction was associated with 20.3 and 13.3 fewer HF events per 100 000 person-years in African Americans and whites, respectively. Estimated event reductions for coronary heart disease and stroke were smaller than for HF, but followed a similar pattern for both population-wide and targeted interventions. Conclusions: Modest population-wide shifts in systolic blood pressure could have a substantial impact on cardiovascular disease incidence and should be developed in parallel with interventions targeting populations with blood pressure above goal. [Description provided by NIOSH]
• Subjects:
  Cardiovascular Diseases Cardiovascular System Epidemiology Occupational Health Safety
• Keywords:
  Author Keywords: Blood Pressure Blood Pressure Cardiovascular Disease Cardiovascular System Disorders Coronary Heart Disease Heart Disease Heart Failure Hypertension Intervention Effectiveness Stroke
• ISSN:
  2047-9980
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Maryland ; Minnesota ; Mississippi ; North Carolina ; OSHA Region 3 ; OSHA Region 4 ; OSHA Region 5
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  4
• Issue:
  10
• NIOSHTIC Number:
  nn:20064293
• Citation:
  J Am Heart Assoc 2015 Oct; 4(10):e002276
• Contact Point Address:
  Shakia T. Hardy, MPH, Cardiovascular Disease Program, Department of Epidemiology, University of North Carolina at Chapel Hill, 137 East Franklin Street, Suite 306-D, Chapel Hill, NC 27514
• Email:
  sthardy@live.unc.edu
• Federal Fiscal Year:
  2016
• Performing Organization:
  University of Minnesota Twin Cities
• Peer Reviewed:
  True
• Start Date:
  20050701
• Source Full Name:
  Journal of the American Heart Association
• End Date:
  20250630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:e1f4f2835c977511998a27b597d5dea1f5324d0450e81bc0946fad01ae75066b0769f64e66a6771bba94347b2f2d6d33013ec21f08be98db6a2addea27ed2a8b
• Download URL:
  https://stacks.cdc.gov/view/cdc/222785/cdc_222785_DS1.pdf
• File Type:
  [PDF - 365.20 KB ]