title: Can Antihypertensive Treatment Restore the Risk of Cardiovascular Disease to Ideal Levels?: The Coronary Artery Risk Development in Young Adults (CARDIA) Study and the Multi-Ethnic Study of Atherosclerosis (MESA).
abstract: BACKGROUND
  It is unclear whether antihypertensive treatment can restore cardiovascular disease risk to the risk level of persons with ideal blood pressure (BP) levels.
  
  
  RESULTS
  Data from the Multi-Ethnic Study of Atherosclerosis (MESA) and the Coronary Artery Risk Development in Young Adults (CARDIA) study were analyzed. Outcomes were compared among participants without or with antihypertensive treatment at 3 BP levels: <120/<80 mm Hg, systolic BP 120 to 139 mm Hg or diastolic BP 80 to 89 mm Hg (120 to 129/≤80 mm Hg for participants with diabetes), and systolic BP ≥140 or diastolic BP ≥90 mm Hg (systolic BP ≥130 or diastolic BP ≥80 mm Hg for participants with diabetes). Among MESA participants aged ≥50 years at baseline, those with BP <120/<80 mm Hg on treatment had higher left ventricular mass index, prevalence of estimated glomerular filtration rate <60 mL/min per 1.73 m(2), prevalence of coronary calcium score >100, and twice the incident cardiovascular disease rate over 9.5 years of follow-up than those with BP <120/<80 mm Hg without treatment. In CARDIA at year 25, persons with BP <120/<80 mm Hg with treatment had much longer exposure to higher BP and higher risk of end-organ damage and subclinical atherosclerosis than those with BP <120/<80 mm Hg without treatment. An exploratory analysis suggested that when cumulative systolic BP was high (eg, >3000 mm Hg-years in 25 years), the increase in left ventricular mass index accelerated.
  
  
  CONCLUSIONS
  The data suggest that based on the current approach, antihypertensive treatment cannot restore cardiovascular disease risk to ideal levels. Emphasis should be placed on primordial prevention of BP increases to further reduce cardiovascular disease morbidity and mortality.
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (K.L., L.A.C., D.M.L.J.).
authors.forename: Kiang
authors.initials: K
authors.lastname: Liu
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (K.L., L.A.C., D.M.L.J.).
authors.forename: Laura A
authors.initials: LA
authors.lastname: Colangelo
authors.affiliation: Institute for Minority Health Research, University of Illinois at Chicago, IL (M.L.D.).
authors.forename: Martha L
authors.initials: ML
authors.lastname: Daviglus
authors.affiliation: Colorado School of Public Health, Aurora, CO (D.C.G.).
authors.forename: David C
authors.initials: DC
authors.lastname: Goff
authors.affiliation: Division of Clinical Epidemiology, Department of Epidemiology and Biostatistics, University of California, San Francisco, CA (M.P.).
authors.forename: Mark
authors.initials: M
authors.lastname: Pletcher
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN (P.J.S.).
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Schreiner
authors.affiliation: Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR (C.T.S.).
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Sibley
authors.affiliation: Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (G.L.B.).
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Burke
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (W.S.P., E.D.M.).
authors.forename: Wendy S
authors.initials: WS
authors.lastname: Post
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (W.S.P., E.D.M.).
authors.forename: Erin D
authors.initials: ED
authors.lastname: Michos
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (K.L., L.A.C., D.M.L.J.).
authors.forename: Donald M
authors.initials: DM
authors.lastname: Lloyd-Jones
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000208:ethnology / Q000503:physiopathology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000208:ethnology / Q000503:physiopathology / Q000517:prevention & control*; D015994:Incidence; D007674:Kidney Diseases / Q000208:ethnology / Q000503:physiopathology / Q000517:prevention & control; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents
keywords: antihypertensive treatment; cardiovascular disease risk; cumulative blood pressure; end‐organ damage